Provider Demographics
NPI:1033268768
Name:JOHNMEYER-SCHUTTE, ERMA (RN,CS,FNP)
Entity Type:Individual
Prefix:
First Name:ERMA
Middle Name:
Last Name:JOHNMEYER-SCHUTTE
Suffix:
Gender:F
Credentials:RN,CS,FNP
Other - Prefix:
Other - First Name:ERMA
Other - Middle Name:RUTH
Other - Last Name:JOHNMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:321 W PROMENADE ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-2719
Mailing Address - Country:US
Mailing Address - Phone:573-582-1234
Mailing Address - Fax:573-582-1212
Practice Address - Street 1:321 W PROMENADE ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2719
Practice Address - Country:US
Practice Address - Phone:573-582-1234
Practice Address - Fax:573-582-1212
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO093272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1033268768Medicaid
MO1033268768Medicaid