Provider Demographics
NPI:1770271363
Name:OHLHAUSEN, CAROLINE AGNES (AGPCNP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:AGNES
Last Name:OHLHAUSEN
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8225 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1107
Mailing Address - Country:US
Mailing Address - Phone:314-368-7487
Mailing Address - Fax:
Practice Address - Street 1:8225 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63117-1107
Practice Address - Country:US
Practice Address - Phone:314-330-4776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023013712208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice