Individual
ELIZABETH JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1111 W PEARCE BLVD, WENTZVILLE, MO 63385-1020
(636) 887-3020
(636) 887-3022
Mailing address
2907 RIDGEWAY AVE, SAINT LOUIS, MO 63114-4546
(314) 938-4438
(314) 938-4434
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2011040126
MO
Other
Enumeration date
01/06/2012
Last updated
10/28/2021
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