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General NPI Number Information
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NPI Number | 1922762665
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Entity Type | Organization
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Legal Business Name | ELITE TELEHEALTH CARE LLC
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Dates
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Enumeration Date | 10/28/2021
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Last Update Date | 10/28/2021
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Provider Practice Location 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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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 | OWNER
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Name | ELIZABETH JOHNSON
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Credential | FNP
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Telephone | 314-938-4438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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