Provider Demographics
NPI:1033420526
Name:KRIEGER, CAROL A (LAC, RN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:KRIEGER
Suffix:
Gender:F
Credentials:LAC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7451 WOODLAWN COLONIAL LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4427
Mailing Address - Country:US
Mailing Address - Phone:314-973-3373
Mailing Address - Fax:
Practice Address - Street 1:11414 GRAVOIS RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-3605
Practice Address - Country:US
Practice Address - Phone:314-973-3373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2014-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011026811171100000X
MA245781171100000X, 171100000X
MO089726163W00000X
IL041.346537163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse