Most Relevant Information
Provider Data
| NPI Number: | 1003323288 |
| Provider Name: | ELIZABETH BURTON WALDEN- PRATER AGNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363L00000X |
| Specialty: | Nurse Practitioner |
| License Number: | 2018004474 |
Most Important Dates
| Enumeration Date: | 01/09/2018 |
| Last Updated: | 05/09/2024 |
Provider Practice Location
1044 N MASON RD
DIV IM GENERAL MED, STE 330
SAINT LOUIS
MO
631416431
Practice Location Phone/Fax
| Phone: | 3149968103 |
| Fax: | 3149963230 |
Provider Mailing Location
PO BOX 60352
SAINT LOUIS
MO
631600352
Provider Mailing Phone/Fax
| Phone: | 3149968103 |
| Fax: | 3149963230 |