Provider Demographics
NPI:1982805354
Name:MEITZ, NICOLE A (ANP-C)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:A
Last Name:MEITZ
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:A
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 298A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-251-6830
Mailing Address - Fax:314-251-5390
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 298A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-6830
Practice Address - Fax:314-251-5390
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000162406363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner