Provider Demographics
NPI:1275006488
Name:CARD, ERICA L (FNP)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:L
Last Name:CARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:MSC 8242-22-02
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-8200
Mailing Address - Fax:833-210-5713
Practice Address - Street 1:1404 CROSS ST
Practice Address - Street 2:DIV SURG UROLOGY
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-2988
Practice Address - Country:US
Practice Address - Phone:314-362-8200
Practice Address - Fax:833-210-5713
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420066310Medicaid