Provider Demographics
NPI:1205315009
Name:SANDERSON, LAUREN CHRISTINE
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:CHRISTINE
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13100 MANCHESTER RD STE 70
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1703
Mailing Address - Country:US
Mailing Address - Phone:313-492-2323
Mailing Address - Fax:
Practice Address - Street 1:13100 MANCHESTER RD STE 70
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1703
Practice Address - Country:US
Practice Address - Phone:314-492-2323
Practice Address - Fax:314-582-1010
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018029470363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner