Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 2016034064 | MO |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 2017013397 | MO |
NPI | 1033659859 |
---|---|
Provider Name | Elizabeth Shipp |
First Address | Saint Louis, MO 63110 |
Second Address | Saint Louis, MO 63104-1016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2017 |
Last Update Date | 01/11/2021 |