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NPI Code Detail

MEDICARE: MS. LEANN N NITZ NP

MEDICARE: MS. LEANN N NITZ NP
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
1363LF0000XFamily Nurse Practitioner2014026213MO

General Provider Information

NPI Number : 1952701666
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LEANN N NITZ NP
Provider Business Mailing Address
First Line : 111 W PORT PLZ STE 600
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63146-3015
Country : US
Telephone Number : 618-335-2478
Fax Number : 636-333-4510
Provider Business Practice Location Address
First Line : 111 W PORT PLZ STE 600
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63146-3015
Country : US
Telephone Number : 618-335-2478
Fax Number : 636-333-4510
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2014
Last Update Date : 12/21/2023

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