Provider Demographics
NPI:1528384823
Name:D'AGOSTINO, MANDY R (FNP-C)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:R
Last Name:D'AGOSTINO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:R
Other - Last Name:HOTMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2230 S SPRINGFIELD AVE
Mailing Address - Street 2:STE H
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-9133
Mailing Address - Country:US
Mailing Address - Phone:417-777-4800
Mailing Address - Fax:417-326-7300
Practice Address - Street 1:2230 S SPRINGFIELD AVE
Practice Address - Street 2:STE H
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-9133
Practice Address - Country:US
Practice Address - Phone:417-777-4800
Practice Address - Fax:417-326-7300
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030009032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily