Healthcare Provider Details

I. General information

NPI: 1255119103
Provider Name (Legal Business Name): SHAUL HORWITZ RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SHMUEL BAIT
JERUSALEM ISRAEL
9103102
IL

IV. Provider business mailing address

23 LAKE FOREST
SAINT LOUIS MO
63117-1304
US

V. Phone/Fax

Practice location:
  • Phone: 972-655-5111
  • Fax:
Mailing address:
  • Phone: 314-647-2619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number228082
License Number StateZZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number904710
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2022045252
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: