Provider Demographics
NPI:1588613582
Name:WHITTLE, AMY E (CRNA)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:E
Last Name:WHITTLE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8054
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-996-8685
Mailing Address - Fax:314-996-8479
Practice Address - Street 1:12634 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6337
Practice Address - Country:US
Practice Address - Phone:314-996-8685
Practice Address - Fax:314-996-8479
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002015494367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILENROLLEDMedicaid
MO917419202Medicaid
MO826940042Medicare PIN
IL$$$$$$$$$001Medicaid