Provider Demographics
NPI:1033415815
Name:DROZDA, MANDY H (PNP)
Entity Type:Individual
Prefix:MS
First Name:MANDY
Middle Name:H
Last Name:DROZDA
Suffix:
Gender:F
Credentials:PNP
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1 CHILDRENS PL
Mailing Address - Street 2:NWT 1230 CB 8116
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-6018
Mailing Address - Fax:314-454-2780
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6018
Practice Address - Fax:314-454-2780
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO155563363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424378800Medicaid