Provider Demographics
NPI:1427348192
Name:MARQUARDT, LOIS ROYLE
Entity type:Individual
Prefix:MS
First Name:LOIS
Middle Name:ROYLE
Last Name:MARQUARDT
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 1:1228 TAKARA CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1013
Mailing Address - Country:US
Mailing Address - Phone:314-453-0414
Mailing Address - Fax:314-469-0005
Practice Address - Street 1:1228 TAKARA CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1013
Practice Address - Country:US
Practice Address - Phone:314-453-0414
Practice Address - Fax:314-469-0005
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner