Provider Demographics
NPI:1518913938
Name:MCNULTY-JENNINGS, ANNIE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:
Last Name:MCNULTY-JENNINGS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10535 LANDSEER DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-4530
Mailing Address - Country:US
Mailing Address - Phone:314-458-7799
Mailing Address - Fax:
Practice Address - Street 1:10535 LANDSEER DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-4530
Practice Address - Country:US
Practice Address - Phone:314-458-7799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO069407367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered