=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033367420
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTIAN HOSPITAL NORTHEAST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2008
-----------------------------------------------------
Last Update Date | 08/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11133 DUNN RD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63136-6119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-653-5582
-----------------------------------------------------
Fax | 314-653-5582
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11133 DUNN RD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63136-6119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-653-5582
-----------------------------------------------------
Fax | 314-653-5582
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADULT NURSE PRACTITIONER
-----------------------------------------------------
Name | MS. ERIKA DONEL SCHULZE
-----------------------------------------------------
Credential | NP-C
-----------------------------------------------------
Telephone | 314-707-7556
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273R00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital Unit
-----------------------------------------------------
License Number | 143531
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------