Healthcare Provider Details

I. General information

NPI: 1326438987
Provider Name (Legal Business Name): ELIZABETH ANN HUGHETT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11133 DUNN RD
SAINT LOUIS MO
63136-6163
US

IV. Provider business mailing address

201 BRAESHIRE DR UNIT E
BALLWIN MO
63021-5673
US

V. Phone/Fax

Practice location:
  • Phone: 314-920-6494
  • Fax:
Mailing address:
  • Phone: 314-920-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number103801
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: