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NPI Code Detail

MEDICARE: GRACE EDERER RN

MEDICARE:   GRACE  EDERER  RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse041.560936IL

General Provider Information

NPI Number : 1609728831
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE EDERER RN
Provider Business Mailing Address
First Line : 9845 HUNTINGDON LN
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63123-6415
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11365 DORSETT RD
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-3411
Country : US
Telephone Number : 314-872-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2026
Last Update Date : 02/11/2026

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