MEDICARE: HEATHER NICOLE ELMORE ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	2001028801	MO

General Provider Information

NPI Number	:	1215263397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER NICOLE ELMORE ANP

Provider Business Mailing Address
First Line	:	4920 AUTUMN OAKS DR
Second Line	:
City	:	MARYVILLE
State	:	IL
Zip	:	62062-8504
Country	:	US
Telephone Number	:	618-205-3251
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 S NEW BALLAS RD
Second Line	:	SUITE 2010
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8253
Country	:	US
Telephone Number	:	314-251-3922
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2009
Last Update Date	:	10/26/2009

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