Individual
MRS. LAUREN KATHRYN SIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
6812 STATE ROUTE 162 STE 200, MARYVILLE, IL 62062-8562
(618) 288-0900
Mailing address
12855 N 40 DR STE 375, SAINT LOUIS, MO 63141-8657
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209018891
IL
Other
Enumeration date
10/03/2019
Last updated
10/03/2019
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