=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598735086
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CONNOR ANDREANO-YOUNG APRN-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2006
-----------------------------------------------------
Last Update Date | 05/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10199 WOODFIELD LN SUITE 10
-----------------------------------------------------
City | OLIVETTE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63132-2922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-298-0023
-----------------------------------------------------
Fax | 314-997-1111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 915 N GRAND BLVD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63106-1621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-652-4100
-----------------------------------------------------
Fax | 314-289-7937
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 2005004203
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 5008378
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------