Provider Demographics
NPI:1891186854
Name:NEUDECKER, ELIZABETH ANN (NP-C)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:ANN
Last Name:NEUDECKER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:15740 S OUTER 40 RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2004
Mailing Address - Country:US
Mailing Address - Phone:636-735-4268
Mailing Address - Fax:
Practice Address - Street 1:15740 S OUTER 40 RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:636-735-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0991633363L00000X
IL209013711363LG0600X
MO2016025273363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner