Provider Demographics
NPI:1558519579
Name:COLLINS, ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3619 RICHARDSON SQUARE DR
Mailing Address - Street 2:STE 170
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-6022
Mailing Address - Country:US
Mailing Address - Phone:636-717-6776
Mailing Address - Fax:636-464-5870
Practice Address - Street 1:3619 RICHARDSON SQUARE DR
Practice Address - Street 2:STE 170
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-6022
Practice Address - Country:US
Practice Address - Phone:636-717-6776
Practice Address - Fax:636-464-5870
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2004035645363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1521013Medicare PIN
MOX93000026Medicare UPIN