Mary Ellen Brockmann, PNP
Individual provider Active NPI Pediatric Nurse Practitioner · Creve Coeur, MO
NPI 1376633362 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1376633362
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- 043919 (MO)
- Practice address
- 522 N New Ballas Rd
Suite 392
Creve Coeur, MO 63141-6857 - Phone
- (314) 994-0444
- Fax
- (314) 994-0555
- NPI assigned
- Oct 13, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 043919 | MO | Yes |
Addresses
Primary practice location
522 N New Ballas Rd
Suite 392
Creve Coeur, MO 63141-6857
Mailing address
522 N New Ballas Rd
Suite 392
Creve Coeur, MO 63141-6857
Phone (314) 994-0444
Other providers in Creve Coeur, MO
- Aaron Michael Brewer
- Sarah Brewer
- Brinkman & Gardiner LLC
- Lacey Brinkman
- Kelly Marie Bristow
- Jeffrey Scott Brooks
- Jason A. Browdy
- Alexis Christina Brown
- Clayton Nelson Brown
- Jessica Brown
All providers in Creve Coeur, MO · Pediatric Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.