Basic Information
| Provider Information | |||||||||
| NPI: | 1275006488 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARD | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 S EUCLID AVE | ||||||||
| Address2: | MSC 8242-22-02 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631101010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143628200 | ||||||||
| FaxNumber: | 8332105713 | ||||||||
| Practice Location | |||||||||
| Address1: | 1404 CROSS ST | ||||||||
| Address2: | DIV SURG UROLOGY | ||||||||
| City: | SHILOH | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622692988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143628200 | ||||||||
| FaxNumber: | 8332105713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2019 | ||||||||
| LastUpdateDate: | 11/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209017882 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 420066310 | 05 | MO | MEDICAID |