MEDICARE: LAUREN ELIZABETH CHURCH ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	20672	TN

General Provider Information

NPI Number	:	1063883056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ELIZABETH CHURCH ANP

Provider Business Mailing Address
First Line	:	1275 DICK LONAS RD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-1382
Country	:	US
Telephone Number	:	865-584-4747
Fax Number	:	865-584-1363

Provider Business Practice Location Address
First Line	:	1275 DICK LONAS RD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-1382
Country	:	US
Telephone Number	:	865-584-4747
Fax Number	:	865-584-1363

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2015
Last Update Date	:	02/23/2021

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