Provider Demographics
NPI:1275610156
Name:FIELDS, LOUISE L (APRN,BC)
Entity Type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:L
Last Name:FIELDS
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 E 5TH ST STE 160
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-3128
Mailing Address - Country:US
Mailing Address - Phone:636-239-8900
Mailing Address - Fax:636-239-8936
Practice Address - Street 1:851 E 5TH ST STE 160
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3128
Practice Address - Country:US
Practice Address - Phone:636-239-8900
Practice Address - Fax:636-239-8936
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO097195363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO097195OtherRN LICENSE
MO097195OtherRN LICENSE
MOP62161Medicare UPIN
MO000081298Medicare PIN
MOP00702892Medicare PIN