Healthcare Provider Details

I. General information

NPI: 1962748699
Provider Name (Legal Business Name): ELIZABETH CAROLINE ESCHMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 W STE MARIES ST
PERRYVILLE MO
63775-1595
US

IV. Provider business mailing address

1321 W STE MARIES ST
PERRYVILLE MO
63775-1595
US

V. Phone/Fax

Practice location:
  • Phone: 573-547-2346
  • Fax:
Mailing address:
  • Phone: 573-547-2346
  • Fax: 636-284-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2012037770
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: