MEDICARE: AMY DANNEMILLER VYN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2025028267	MO

General Provider Information

NPI Number	:	1407710627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY DANNEMILLER VYN

Provider Business Mailing Address
First Line	:	1204 SIMMONS AVE
Second Line	:
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-1113
Country	:	US
Telephone Number	:	513-967-8537
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 S NEW BALLAS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8702
Country	:	US
Telephone Number	:	314-251-6710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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