Healthcare Provider Details

I. General information

NPI: 1710232905
Provider Name (Legal Business Name): ELIZABETH ANN CREWS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 OLD FARM RD E
MEXICO MO
65265-4200
US

IV. Provider business mailing address

670 MASON RIDGE CENTER DR STE 300
SAINT LOUIS MO
63141-8573
US

V. Phone/Fax

Practice location:
  • Phone: 573-581-2455
  • Fax: 573-581-2702
Mailing address:
  • Phone: 573-581-2455
  • Fax: 573-581-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2012023711
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: