Provider Demographics
NPI:1689061285
Name:MOLITOR, AMANDA L (ACNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:MOLITOR
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:SCHMITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:11475 OLDE CABIN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7129
Mailing Address - Country:US
Mailing Address - Phone:314-991-8210
Mailing Address - Fax:314-991-8206
Practice Address - Street 1:607 S NEW BALLAS RD STE T1275
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8222
Practice Address - Country:US
Practice Address - Phone:314-251-6844
Practice Address - Fax:314-251-4337
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015008335363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care