Individual
MS. ELLEN CLAIRE CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
625 S NEW BALLAS RD STE 2015, SAINT LOUIS, MO 63141-8253
(314) 251-1700
Mailing address
625 S NEW BALLAS RD STE 2015, SAINT LOUIS, MO 63141-8253
(314) 251-1700
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
2017038788
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420049783
—
MO
Enumeration date
11/05/2017
Last updated
01/30/2023
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