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General NPI Number Information
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NPI Number | 1073883146
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Entity Type | Individual
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Provider Name | ELIZABETH JOHNSON FNP
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Gender | Female
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Dates
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Enumeration Date | 01/06/2012
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Last Update Date | 10/28/2021
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Provider Practice Location Address
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Address Line | 1111 W PEARCE BLVD
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City | WENTZVILLE
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State | MO
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Zip | 63385-1020
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Country | US
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Telephone | 636-887-3020
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Fax | 636-887-3022
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Provider Business Mailing Address
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Address Line | 2907 RIDGEWAY AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63114-4546
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Country | US
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Telephone | 314-938-4438
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Fax | 314-938-4434
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2011040126
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License Number State | MO
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