Provider Demographics
NPI:1376325597
Name:VENUTO, ALEXANDRA LOUISE (AGNP)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:LOUISE
Last Name:VENUTO
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-286-1967
Mailing Address - Fax:314-286-1985
Practice Address - Street 1:4488 FOREST PARK AVE
Practice Address - Street 2:DIV NEUROLOGY AGING AND DEMENTIA, STE 160
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2283
Practice Address - Country:US
Practice Address - Phone:314-286-1967
Practice Address - Fax:314-286-1985
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024002810363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care