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General NPI Number Information
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NPI Number | 1487112215
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Entity Type | Individual
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Provider Name | ELIZABETH ALLISON RUTH BERWALDT FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/11/2019
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Last Update Date | 03/03/2023
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Provider Practice Location Address
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Address Line | 2790 CLAY EDWARDS DR STE 520
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City | NORTH KANSAS CITY
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State | MO
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Zip | 64116-3274
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Country | US
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Telephone | 816-221-6750
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Fax | 816-221-7280
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Provider Business Mailing Address
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Address Line | 9411 N. OAK TRAFFICWAY LL1
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City | KANSAS CITY
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State | MO
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Zip | 64155-2144
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Country | US
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Telephone | 816-691-1655
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Fax | 913-428-2951
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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 | 2022046158
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5378555072
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License Number State | KS
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