Healthcare Provider Details

I. General information

NPI: 1093167843
Provider Name (Legal Business Name): CHRISTINE ELIZABETH NANCE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11133 DUNN RD
SAINT LOUIS MO
63136-6163
US

IV. Provider business mailing address

409 N DEER TRACKS TRL
SAINT PETERS MO
63376-5907
US

V. Phone/Fax

Practice location:
  • Phone: 314-653-5000
  • Fax:
Mailing address:
  • Phone: 618-780-7645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2017002558
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209016473
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number2010007231
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: