Provider Demographics
NPI:1649676214
Name:AMSTERDAM-BALZER, ADENE S (RN)
Entity type:Individual
Prefix:
First Name:ADENE
Middle Name:S
Last Name:AMSTERDAM-BALZER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ADENE
Other - Middle Name:S
Other - Last Name:PARRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-851-1000
Mailing Address - Fax:314-851-4447
Practice Address - Street 1:12655 OLIVE BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6362
Practice Address - Country:US
Practice Address - Phone:314-851-1000
Practice Address - Fax:314-851-4447
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008003972163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse