Provider Demographics
NPI:1003942772
Name:WILMESHERR, ELIZABETH ANN (MA, F-AAA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:WILMESHERR
Suffix:
Gender:F
Credentials:MA, F-AAA
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:KRUEL
Other - Last Name:WILMESHERR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, F-AAA
Mailing Address - Street 1:102 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-1610
Mailing Address - Country:US
Mailing Address - Phone:636-583-4902
Mailing Address - Fax:636-583-4925
Practice Address - Street 1:102 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-1610
Practice Address - Country:US
Practice Address - Phone:636-583-4902
Practice Address - Fax:636-583-4925
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00989231H00000X
MO000475237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO45-00071OtherUNITED HEALTH CARE
MO23445OtherMERCY HEALTH PLAN
MO107868OtherBLUE CROSS BLUE SHIELD
MO486809OtherHEALTHLINK