Provider Demographics
NPI:1043707409
Name:RANGE, LAUREN (NP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:RANGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 PARK 270 DR STE 150
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4038
Mailing Address - Country:US
Mailing Address - Phone:314-682-3400
Mailing Address - Fax:
Practice Address - Street 1:1801 PARK 270 DR STE 150
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4038
Practice Address - Country:US
Practice Address - Phone:314-682-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017358363LF0000X
MO2022006449363LP0808X
MO2017044027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health