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Individual

MRS. ELIZABETH RODERICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN-BC

Contact information

Practice address
5301 FARAON ST STE 220, SAINT JOSEPH, MO 64506-3800
(816) 271-8131
(816) 271-8132
Mailing address
5301 FARAON ST STE 220, SAINT JOSEPH, MO 64506-3800
(816) 271-8131
(816) 271-8132

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
138383
MO
363LF0000X
Family Nurse Practitioner
Primary
138383
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1801099874
MO
05
200672230A
KS
05
428451702
MO
Enumeration date
06/07/2007
Last updated
05/16/2011
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