Healthcare Provider Details

I. General information

NPI: 1649665118
Provider Name (Legal Business Name): ELIZABETH HOWARD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH EWIG PA-C

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12855 N 40 DR STE 280
SAINT LOUIS MO
63141-8657
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-4700
US

V. Phone/Fax

Practice location:
  • Phone: 314-432-4415
  • Fax: 314-432-1986
Mailing address:
  • Phone: 314-432-4415
  • Fax: 314-432-1986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085005440
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2018011002
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: