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General NPI Number Information
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NPI Number | 1811548035
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Entity Type | Individual
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Provider Name | AUDREY FAULSTICH DNP, APRN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/28/2019
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Last Update Date | 11/22/2023
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Provider Practice Location Address
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Address Line | 925 MADISON AVE FRNT
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City | MADISON
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State | IL
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Zip | 62060-1316
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Country | US
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Telephone | 314-602-7340
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Fax |
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Provider Business Mailing Address
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Address Line | 4728 LOCKE AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63109-2722
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Country | US
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Telephone | 314-602-7340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209020154
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License Number State | IL
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