Individual
MRS. MARY ELIZABETH PAGANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
5213 GODFREY RD STE 110, GODFREY, IL 62035-2510
(618) 618-6193
(618) 619-3390
Mailing address
660 MASON RIDGE CENTER DR STE 300, SAINT LOUIS, MO 63141-8512
(314) 448-3791
(314) 996-7658
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
041453981
IL
163WG0000X
General Practice Registered Nurse
2002007982
MO
363L00000X
Nurse Practitioner
Primary
209017735
IL
363LF0000X
Family Nurse Practitioner
2018012503
MO
363LF0000X
Family Nurse Practitioner
209017735
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2018012503
MO NP LICENSE NUMBER
MO
Enumeration date
08/01/2018
Last updated
09/19/2025
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