Provider Demographics
NPI:1598912040
Name:NEUMANN, ELLEN JANE (APN, ANP-BC, MSN)
Entity Type:Individual
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First Name:ELLEN
Middle Name:JANE
Last Name:NEUMANN
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Gender:F
Credentials:APN, ANP-BC, MSN
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Mailing Address - Street 1:12255 DE PAUL DR
Mailing Address - Street 2:SUITE 700
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2510
Mailing Address - Country:US
Mailing Address - Phone:314-739-4166
Mailing Address - Fax:314-739-2485
Practice Address - Street 1:12655 OLIVE BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6362
Practice Address - Country:US
Practice Address - Phone:314-851-1000
Practice Address - Fax:314-851-4468
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2010-02-09
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Provider Licenses
StateLicense IDTaxonomies
MO085537363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
124510015Medicare PIN