Healthcare Provider Details

I. General information

NPI: 1609279025
Provider Name (Legal Business Name): ELIZABETH ANN HUENEFELDT NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS ELIZABETH ANN MILES

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD STE 260C
SAINT LOUIS MO
63131-2382
US

IV. Provider business mailing address

3009 N BALLAS RD STE 260C
SAINT LOUIS MO
63131-2382
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-7940
  • Fax:
Mailing address:
  • Phone: 314-996-7940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2014022526
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014022526
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: