Provider Demographics
NPI:1740304948
Name:DOWNEY, ELIZABETH R
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:R
Last Name:DOWNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11365 DORSETT RD.
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043
Mailing Address - Country:US
Mailing Address - Phone:314-872-6430
Mailing Address - Fax:314-872-6500
Practice Address - Street 1:11365 DORSETT RD.
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043
Practice Address - Country:US
Practice Address - Phone:314-872-6430
Practice Address - Fax:314-872-6500
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO124767363LP0200X, 163W00000X
MO000124767363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO426040903Medicaid