Individual
ELIZABETH DARCANGELIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
3635 VISTA AT GRAND BLVD, ST LOUIS, MO 63110-0250
(314) 577-8776
(314) 268-5697
Mailing address
3691 RUTGER ST, PROVIDER ENROLLMENT, SAINT LOUIS, MO 63110-2515
(314) 977-4440
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
117364
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00657539
RR MEDICARE
MO
Enumeration date
04/20/2006
Last updated
02/10/2009
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