Provider Demographics
NPI:1417784430
Name:CARAVELLI, AMANDA (APRN - CNS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CARAVELLI
Suffix:
Gender:F
Credentials:APRN - CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:MO
Mailing Address - Zip Code:65453-5114
Mailing Address - Country:US
Mailing Address - Phone:314-922-3210
Mailing Address - Fax:
Practice Address - Street 1:8300 EAGER RD STE 2F
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-1405
Practice Address - Country:US
Practice Address - Phone:314-326-8024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024036773364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist