Provider Demographics
NPI:1033229190
Name:FRANTZ, MARY ELLEN (CRNA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:FRANTZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 CONSORT DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4439
Mailing Address - Country:US
Mailing Address - Phone:636-200-4242
Mailing Address - Fax:636-200-4243
Practice Address - Street 1:17050 BAXTER RD
Practice Address - Street 2:SUITE #110
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1422
Practice Address - Country:US
Practice Address - Phone:636-200-4242
Practice Address - Fax:636-200-4243
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO122106367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO914765136Medicaid
MO914765136Medicaid