Healthcare Provider Details

I. General information

NPI: 1437632957
Provider Name (Legal Business Name): ELIZABETH ASHLEY MEFFERT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E MARKET ST UNIT 3116
SAN ANTONIO TX
78205-2683
US

IV. Provider business mailing address

610 E MARKET ST UNIT 3116
SAN ANTONIO TX
78205-2683
US

V. Phone/Fax

Practice location:
  • Phone: 512-762-6046
  • Fax:
Mailing address:
  • Phone: 512-762-6046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number769184
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: