Provider Demographics
NPI:1063851830
Name:CARQUEVILLE, LAUREN ELISE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELISE
Last Name:CARQUEVILLE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S KIRKWOOD RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-7250
Mailing Address - Country:US
Mailing Address - Phone:314-525-4225
Mailing Address - Fax:314-525-4229
Practice Address - Street 1:1001 S KIRKWOOD RD STE 300
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-7250
Practice Address - Country:US
Practice Address - Phone:314-525-4225
Practice Address - Fax:314-525-4229
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010482363LF0000X
MO2018003099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily