Individual
MS. LAURA ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
12277 DE PAUL DR STE 403, BRIDGETON, MO 63044-2536
(314) 738-2715
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2013035666
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598193187
NPI
MO
05
—
1598193187
—
MO
01
—
1760626147
GROUP NPI
MO
01
—
MA1721
MEDICARE GROUP PTAN
MO
Enumeration date
10/17/2013
Last updated
11/18/2020
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