Healthcare Provider Details

I. General information

NPI: 1396573523
Provider Name (Legal Business Name): ELEISHA R. MARCH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12680 OLIVE BLVD STE 300
SAINT LOUIS MO
63141-6322
US

IV. Provider business mailing address

408 MONTCLAIR TOWER DR
SAINT CHARLES MO
63303-4086
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-8888
  • Fax: 314-251-8889
Mailing address:
  • Phone: 573-660-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024019262
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: