Healthcare Provider Details

I. General information

NPI: 1427348192
Provider Name (Legal Business Name): MS. LOIS ROYLE MARQUARDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 TAKARA CT
SAINT LOUIS MO
63131-1013
US

IV. Provider business mailing address

1228 TAKARA CT
SAINT LOUIS MO
63131-1013
US

V. Phone/Fax

Practice location:
  • Phone: 314-453-0414
  • Fax: 314-469-0005
Mailing address:
  • Phone: 314-453-0414
  • Fax: 314-469-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: