Provider Demographics
NPI:1306838651
Name:VENEGONI-JAMES, ANN (RNC OGNP)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:
Last Name:VENEGONI-JAMES
Suffix:
Gender:F
Credentials:RNC OGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12255 DEPAUL DRIVE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044
Mailing Address - Country:US
Mailing Address - Phone:314-291-2975
Mailing Address - Fax:314-291-2783
Practice Address - Street 1:12255 DEPAUL DRIVE
Practice Address - Street 2:SUITE 360
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044
Practice Address - Country:US
Practice Address - Phone:314-291-2975
Practice Address - Fax:314-291-2783
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110258363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS10016Medicare UPIN