Healthcare Provider Details

I. General information

NPI: 1487019394
Provider Name (Legal Business Name): ERICKA LAUREN LOUER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2015
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL STE C STE C
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

1 CHILDRENS PL NWT 1230
SAINT LOUIS MO
63110-1002
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6124
  • Fax: 314-454-4861
Mailing address:
  • Phone: 314-454-6124
  • Fax: 314-454-4861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2015016090
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015016090
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: