Provider Demographics
NPI:1790230019
Name:VANDER KOOI, DANA LOUISE (NP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LOUISE
Last Name:VANDER KOOI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:LOUISE
Other - Last Name:VALLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:16100 CHESTERFIELD PKWY W STE 260
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4836
Mailing Address - Country:US
Mailing Address - Phone:636-778-9427
Mailing Address - Fax:636-778-9632
Practice Address - Street 1:16100 CHESTERFIELD PKWY W STE 260
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4836
Practice Address - Country:US
Practice Address - Phone:314-778-9427
Practice Address - Fax:636-778-9632
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016028436163W00000X
MO2020041306363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse