Healthcare Provider Details

I. General information

NPI: 1003349523
Provider Name (Legal Business Name): EVA C SCHULTE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVA C LUCK

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13515 BARRETT PARKWAY DR STE 170
BALLWIN MO
63021-5870
US

IV. Provider business mailing address

400 S WOODS MILL RD STE 140
CHESTERFIELD MO
63017-3429
US

V. Phone/Fax

Practice location:
  • Phone: 314-775-2811
  • Fax: 314-775-2821
Mailing address:
  • Phone: 314-485-1101
  • Fax: 314-485-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2017010995
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: