Healthcare Provider Details

I. General information

NPI: 1093978678
Provider Name (Legal Business Name): ELISHA F SCHNIEDERS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISHA F SCHNIEDERS CPNP

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 HAMACHER ST SUITE 103
WATERLOO IL
62298-1592
US

IV. Provider business mailing address

6804 LINDENWOOD PL
SAINT LOUIS MO
63109-1248
US

V. Phone/Fax

Practice location:
  • Phone: 618-939-2273
  • Fax:
Mailing address:
  • Phone: 618-806-2966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number2003017875
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2003017875
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number041416808
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: