MEDICARE: DR. ELIZABETH E MERRITT DNP, CPNP

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	163W00000X	Registered Nurse	120225	MO
2	363LP0200X	Pediatric Nurse Practitioner	277000115	IL
3	363LP0200X	Pediatric Nurse Practitioner	120225	MO
4	163W00000X	Registered Nurse	041454069	IL

General Provider Information

NPI Number	:	1558337519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH E MERRITT DNP, CPNP

Provider Business Mailing Address
First Line	:	1 CHILDREN'S PLACE
Second Line	:	CB 8116
City	:	ST. LOUIS
State	:	MO
Zip	:	63110
Country	:	US
Telephone Number	:	314-454-2341
Fax Number	:	314-454-4345

Provider Business Practice Location Address
First Line	:	11133 DUNN RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6163
Country	:	US
Telephone Number	:	314-454-2341
Fax Number	:	314-454-4345

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	02/07/2020

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