Healthcare Provider Details

I. General information

NPI: 1952842684
Provider Name (Legal Business Name): MORGAN ELIZABETH GROTHAUS BSN, MSN, RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORGAN HARRIS

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 VISTA AVE
SAINT LOUIS MO
63110
US

IV. Provider business mailing address

8815 CALEB RD
ARGENTA IL
62501-8191
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-6100
  • Fax:
Mailing address:
  • Phone: 217-855-7409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2013006432
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041404099
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017005259
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: