MEDICARE: MRS. ANNIE MCNULTY-JENNINGS CRNA

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	367500000X	Certified Registered Nurse Anesthetist	069407	MO

General Provider Information

NPI Number	:	1518913938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNIE MCNULTY-JENNINGS CRNA

Provider Business Mailing Address
First Line	:	10535 LANDSEER DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-4530
Country	:	US
Telephone Number	:	314-458-7799
Fax Number	:

Provider Business Practice Location Address
First Line	:	10535 LANDSEER DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-4530
Country	:	US
Telephone Number	:	314-458-7799
Fax Number	:

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	05/13/2026

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