Provider Demographics
NPI:1891093050
Name:HARTBECK, ELIZABETH BROUGHTON (PNP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:BROUGHTON
Last Name:HARTBECK
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
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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:314-454-6022
Mailing Address - Fax:866-422-8308
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV SURG PED, STE 2A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6022
Practice Address - Fax:866-422-8308
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2011006157363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425546009Medicaid
ILENROLLEDMedicaid