Healthcare Provider Details

I. General information

NPI: 1629842927
Provider Name (Legal Business Name): ELENA P KUZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELENA PASIKATAN

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 S JEFFERSON ST
AVA MO
65608-5530
US

IV. Provider business mailing address

1601 OLD SOUTH RIVER RD
SAINT CHARLES MO
63303-4120
US

V. Phone/Fax

Practice location:
  • Phone: 417-683-2786
  • Fax:
Mailing address:
  • Phone: 636-224-1210
  • Fax: 636-246-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2021002615
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: