Provider Demographics
NPI:1902137151
Name:ROBERTS, CARMEN RENE (ANP)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:RENE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:ANP
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8086
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-1291
Mailing Address - Fax:314-454-8250
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:STE 8A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-1291
Practice Address - Fax:314-454-8250
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2015-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2010007623363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL50621644Medicaid