Healthcare Provider Details

I. General information

NPI: 1356580260
Provider Name (Legal Business Name): ELIZABETH ANN SCHICKLER PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 6006B
SAINT LOUIS MO
63141-8273
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6299
  • Fax:
Mailing address:
  • Phone: 314-251-6299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2003013769
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: