Individual
ELIZABETH ANN BOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2630 HIGHWAY K STE 100, O FALLON, MO 63368-6624
(636) 240-5454
Mailing address
2630 HIGHWAY K STE 100, O FALLON, MO 63368-6624
(636) 240-5454
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085003294
IL
363A00000X
Physician Assistant
Primary
2022029696
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
033352
HEALTH ALLIANCE
IL
05
—
036067104
—
IL
01
—
10019630
BLUE CROSS BLUE SHIELD
IL
01
—
115574
HEALTHLINK
IL
01
—
143870
MEDICARE RAILROAD
IL
Enumeration date
09/09/2008
Last updated
05/02/2023
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