MEDICARE: MRS. AMY CHRISTINE LEDIOYT-FUHR RN

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	163W00000X	Registered Nurse	151074	MO

General Provider Information

NPI Number	:	1659650307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY CHRISTINE LEDIOYT-FUHR RN

Provider Business Mailing Address
First Line	:	641 OAKWOOD AVE
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63119
Country	:	US
Telephone Number	:	314-918-8576
Fax Number	:

Provider Business Practice Location Address
First Line	:	641 OAKWOOD AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-2660
Country	:	US
Telephone Number	:	314-918-8576
Fax Number	:

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

Provider Enumeration Date	:	08/12/2011
Last Update Date	:	08/12/2011

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