Healthcare Provider Details

I. General information

NPI: 1912210378
Provider Name (Legal Business Name): LISA SIMONE HERZING FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8888 LADUE RD STE 210
SAINT LOUIS MO
63124-2056
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-2834
US

V. Phone/Fax

Practice location:
  • Phone: 314-862-5044
  • Fax: 314-862-2734
Mailing address:
  • Phone: 314-862-5044
  • Fax: 314-862-2734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2010022185
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2010022185
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209008271
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: