Provider Demographics
NPI:1851570329
Name:REAGAN, ANNA M (RN, APRN)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:REAGAN
Suffix:
Gender:F
Credentials:RN, APRN
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:M
Other - Last Name:REAGAN-WALLICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN BC
Mailing Address - Street 1:PO BOX 955534
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-5534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1035 BELLEVUE AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1854
Practice Address - Country:US
Practice Address - Phone:314-647-8269
Practice Address - Fax:314-646-1700
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO085839363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health