Healthcare Provider Details

I. General information

NPI: 1861742454
Provider Name (Legal Business Name): LAUREN MICHELLE ULRICH CNM, MSN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11152 DE MALLE DR
SAINT LOUIS MO
63146-5304
US

IV. Provider business mailing address

11152 DE MALLE DR
SAINT LOUIS MO
63146-5304
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-9779
  • Fax:
Mailing address:
  • Phone: 314-991-9779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2011002066
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: