MEDICARE: ELENA LUISA MAY-PLAZA APRN

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
1	363LF0000X	Family Nurse Practitioner	2017008171	MO

General Provider Information

NPI Number	:	1730686700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA LUISA MAY-PLAZA APRN

Provider Business Mailing Address
First Line	:	103 BRIARWOOD CIR
Second Line	:
City	:	CRYSTAL CITY
State	:	MO
Zip	:	63019-1401
Country	:	US
Telephone Number	:	636-524-9704
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 BRIARWOOD CIR
Second Line	:
City	:	CRYSTAL CITY
State	:	MO
Zip	:	63019-1401
Country	:	US
Telephone Number	:	636-524-9704
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2018
Last Update Date	:	04/06/2018

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