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General NPI Number Information
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NPI Number | 1053887612
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Entity Type | Organization
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Legal Business Name | ST. GIANNA PEDIATRICS, LLC
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Dates
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Enumeration Date | 10/22/2018
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 7387 WATSON ROAD
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City | SHREWSBURY
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State | MO
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Zip | 63119
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Country | US
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Telephone | 314-500-5437
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Fax | 314-500-5683
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Provider Business Mailing Address
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Address Line | 7387 WATSON ROAD
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City | SHREWSBURY
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State | MO
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Zip | 63119
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Country | US
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Telephone | 314-500-5437
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Fax | 314-500-5683
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELIZABETH C. ABRAHAM
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Credential | MD
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Telephone | 314-808-5354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0210X
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Taxonomy Name | Pediatric Nephrology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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