Healthcare Provider Details

I. General information

NPI: 1558337519
Provider Name (Legal Business Name): ELIZABETH E MERRITT DNP, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11133 DUNN RD
SAINT LOUIS MO
63136-6163
US

IV. Provider business mailing address

1 CHILDREN'S PLACE CB 8116
ST. LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-2341
  • Fax: 314-454-4345
Mailing address:
  • Phone: 314-454-2341
  • Fax: 314-454-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number120225
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number277000115
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number120225
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041454069
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: