Provider Demographics
NPI:1093978678
Name:SCHNIEDERS, ELISHA F (CPNP)
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:F
Last Name:SCHNIEDERS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:ELISHA
Other - Middle Name:F
Other - Last Name:SCHNIEDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPNP
Mailing Address - Street 1:6804 LINDENWOOD PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-1248
Mailing Address - Country:US
Mailing Address - Phone:618-806-2966
Mailing Address - Fax:
Practice Address - Street 1:509 HAMACHER ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1592
Practice Address - Country:US
Practice Address - Phone:618-939-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003017875163WP0200X, 363LP0200X
IL041416808363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics