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General NPI Number Information
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NPI Number | 1710232905
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Entity Type | Individual
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Provider Name | ELIZABETH ANN CREWS FNP
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Gender | Female
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Dates
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Enumeration Date | 07/13/2012
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Last Update Date | 06/14/2017
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Provider Practice Location Address
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Address Line | 1051 OLD FARM RD E
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City | MEXICO
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State | MO
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Zip | 65265-4200
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Country | US
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Telephone | 573-581-2455
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Fax | 573-581-2702
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Provider Business Mailing Address
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Address Line | 670 MASON RIDGE CENTER DR STE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8573
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Country | US
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Telephone | 573-581-2455
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Fax | 573-581-2702
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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 | 2012023711
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License Number State | MO
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