Provider Demographics
NPI:1952813958
Name:MCDONNELL, ANGELA KRISTEEN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KRISTEEN
Last Name:MCDONNELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 SHUTTEN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-8034
Mailing Address - Country:US
Mailing Address - Phone:636-288-5135
Mailing Address - Fax:
Practice Address - Street 1:330 1ST CAPITOL DR STE 470
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2847
Practice Address - Country:US
Practice Address - Phone:636-946-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017016303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily