Dr. Lisa S. Etzwiler
Pediatric Emergency Physician
621 S New Ballas Rd St. John's Mercy Medical Center, Suite 6006, Tower B
Creve Coeur
, Missouri 63141-8232
Dr. Lisa S. Etzwiler
Pediatric Emergency Physician
621 S New Ballas Rd St. John's Mercy Medical Center, Suite 6006, Tower B
Creve Coeur
, Missouri 63141-8232
(636) 536-4973
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About
Features
Specialties
- Pediatric Emergency Physician
Languages spoken
- English
Location
First Address
- Dr. Lisa S. Etzwiler
- 16522 Baxter Forest Ridge Dr
- Chesterfield, MO
- Zip : 63005-4661
- Fax : (636) 536-4973
- Phone : (636) 519-1655
Second Address
- Dr. Lisa S. Etzwiler
- 621 S New Ballas Rd St. John's Mercy Medical Center, Suite 6006, Tower B
- Creve Coeur, MO
- Zip : 63141-8232
- Fax : (314) 251-4450
- Phone : (314) 251-6299
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207PP0204X | Pediatric Emergency Physician | 102051 | MO |
National Provider Identifier
| NPI | 1740398593 |
|---|---|
| Provider Name | Dr. Lisa S. Etzwiler |
| First Address | Chesterfield, MO 63005-4661 |
| Second Address | Creve Coeur, MO 63141-8232 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 29/08/2006 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| EO1258 | (02) | MO |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.