Organization
ESRY STUDENT HEALTH CENTER MISSOURI WESTERN STATE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH RODERICK FNP (NURSE PRACTICTIONER)
(816) 271-4495
Entity
Organization
Contact information
Practice address
4525 DOWNS DR, BLUM UNION ROOM 203, SAINT JOSEPH, MO 64507-2246
(816) 271-4495
(816) 271-4496
Mailing address
4525 DOWNS DR, BLUM UNION ROOM 203, SAINT JOSEPH, MO 64507-2246
(816) 271-4495
(816) 271-4496
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
138383
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1801099874
NP TYPE I NPI
MO
Enumeration date
05/18/2016
Last updated
05/18/2016
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