Provider Demographics
NPI:1275741266
Name:MOSE, ANDREA L (FNP, WHNP)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:L
Last Name:MOSE
Suffix:
Gender:F
Credentials:FNP, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 WENTZVILLE PKWY
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3408
Mailing Address - Country:US
Mailing Address - Phone:636-497-4000
Mailing Address - Fax:
Practice Address - Street 1:1520 WENTZVILLE PKWY
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3408
Practice Address - Country:US
Practice Address - Phone:636-497-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO146573363LW0102X
MO2017029848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO427357900Medicaid
MOP01135333OtherRAILROAD MEDICARE
IL$$$$$$$$$001Medicaid
834680217Medicare PIN
Q79258Medicare UPIN
IL$$$$$$$$$001Medicaid