Provider Demographics
NPI:1558457069
Name:FLACH, ELIZABETH M (CRNA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:FLACH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:M
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3015 N. BALLAS RD
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:63131
Mailing Address - Country:US
Mailing Address - Phone:314-996-5330
Mailing Address - Fax:314-810-1399
Practice Address - Street 1:3015 N. BALLAS RD
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MS
Practice Address - Zip Code:63131
Practice Address - Country:US
Practice Address - Phone:314-996-5330
Practice Address - Fax:314-810-1399
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO074785367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00391453OtherRAILROAD MEDICARE
MO911618403Medicaid
MO911618403Medicaid