MEDICARE: LUCIJA KOZUL SADL AGPCNP-BC AND NP-C

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	363L00000X	Nurse Practitioner	2017044038	MO
2	363LA2200X	Adult Health Nurse Practitioner	2017018302	MO
3	363LA2200X	Adult Health Nurse Practitioner	AG11170104	MO

General Provider Information

NPI Number	:	1912413584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCIJA KOZUL SADL AGPCNP-BC AND NP-C

Provider Business Mailing Address
First Line	:	PO BOX 959203
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-9203
Country	:	US
Telephone Number	:	314-305-1447
Fax Number	:	314-996-4546

Provider Business Practice Location Address
First Line	:	3009 N BALLAS RD STE 383C
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2324
Country	:	US
Telephone Number	:	314-305-1447
Fax Number	:	314-996-4546

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

Provider Enumeration Date	:	12/19/2017
Last Update Date	:	03/09/2026

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