=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033707344
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN POHLE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2021
-----------------------------------------------------
Last Update Date | 09/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10334 MANCHESTER RD
-----------------------------------------------------
City | KIRKWOOD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63122-1521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-369-2897
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10334 MANCHESTER RD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63122-1521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 2021003410
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------