MEDICARE: HEATHER M. ST. AMOUR NP

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	363LA2200X	Adult Health Nurse Practitioner	310039	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700486065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER M. ST. AMOUR NP

Provider Business Mailing Address
First Line	:	50 S B B KING BLVD # 100
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38103-2626
Country	:	US
Telephone Number	:	901-436-1381
Fax Number	:

Provider Business Practice Location Address
First Line	:	5015 CAMPUSWOOD DR
Second Line	:
City	:	EAST SYRACUSE
State	:	NY
Zip	:	13057-4232
Country	:	US
Telephone Number	:	315-204-0397
Fax Number	:

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

Provider Enumeration Date	:	10/27/2020
Last Update Date	:	09/09/2024

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