Basic Information
| Provider Information | |||||||||
| NPI: | 1598912040 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEUMANN | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | JANE | ||||||||
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| Credential: | APN, ANP-BC, MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12255 DE PAUL DR | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | BRIDGETON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630442510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147394166 | ||||||||
| FaxNumber: | 3147392485 | ||||||||
| Practice Location | |||||||||
| Address1: | 12655 OLIVE BLVD | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631416362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148511000 | ||||||||
| FaxNumber: | 3148514468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2008 | ||||||||
| LastUpdateDate: | 02/09/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 085537 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.