Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 2017013760 | MO |
NPI | 1588194427 |
---|---|
Provider Name | Amanda Agee |
First Address | Chesterfield, MO 63017-2004 |
Second Address | Chesterfield, MO 63017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2017 |
Last Update Date | 24/05/2019 |