Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 2018028414 | MO |
NPI | 1336628247 |
---|---|
Provider Name | Mrs. Elizabeth Nicole Crank |
First Address | St. Louis, MO 63110-1077 |
Second Address | Saint Louis, MO 63110-1081 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2018 |
Last Update Date | 29/04/2021 |