Provider Demographics
NPI:1114223278
Name:OWEN ELFANBAUM, NANCY L
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:L
Last Name:OWEN ELFANBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2178 SEVEN PINES DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-2216
Mailing Address - Country:US
Mailing Address - Phone:314-439-9678
Mailing Address - Fax:
Practice Address - Street 1:2178 SEVEN PINES DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-2216
Practice Address - Country:US
Practice Address - Phone:314-439-9678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula