Healthcare Provider Details

I. General information

NPI: 1699305334
Provider Name (Legal Business Name): LISA MARIE SCHUSTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 DEPAUL DRIVE SUITE 600
BRIDGETON MO
63044-2515
US

IV. Provider business mailing address

PO BOX 955534
SAINT LOUIS MO
63195-2551
US

V. Phone/Fax

Practice location:
  • Phone: 314-209-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number2016037561
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2020002481
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: