Provider Demographics
NPI:1780011023
Name:KURTOVIC, ELVISA (ANP)
Entity Type:Individual
Prefix:MS
First Name:ELVISA
Middle Name:
Last Name:KURTOVIC
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:636-916-7140
Mailing Address - Fax:636-916-7139
Practice Address - Street 1:100 ENTRANCE WAY
Practice Address - Street 2:DEPT NEUROLOGICAL SURGERY, STE B
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1645
Practice Address - Country:US
Practice Address - Phone:636-916-7140
Practice Address - Fax:636-916-7139
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013036187363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420009924Medicaid
ILENROLLEDMedicaid