Provider Demographics
NPI:1902390180
Name:PILGER, ELISE CATHERINE (AGNP-C)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:CATHERINE
Last Name:PILGER
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1742 W WOODIE PROCTOR RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-8886
Mailing Address - Country:US
Mailing Address - Phone:573-424-2421
Mailing Address - Fax:660-882-3188
Practice Address - Street 1:1417 BINGHAM RD
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-2229
Practice Address - Country:US
Practice Address - Phone:660-882-8018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2024-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018021112363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner