Provider Demographics
NPI:1295490159
Name:VANUYTVEN, EMILY RAEANN (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:RAEANN
Last Name:VANUYTVEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:RAEANN-VANUYTVEN
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:660 MASON RIDGE CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8512
Mailing Address - Country:US
Mailing Address - Phone:314-448-3791
Mailing Address - Fax:314-996-7658
Practice Address - Street 1:4700 MEMORIAL DR STE 210
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5373
Practice Address - Country:US
Practice Address - Phone:618-767-7700
Practice Address - Fax:618-257-6794
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022010295363LF0000X
MT183938363LF0000X
NM65798363LF0000X
IL209026329363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily