MEDICARE: LAUREN LEIGH RAIA FNP-C

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	222751	AZ

General Provider Information

NPI Number	:	1932930088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN LEIGH RAIA FNP-C

Provider Business Mailing Address
First Line	:	15000 N 83RD AVE UNIT 200
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-2002
Country	:	US
Telephone Number	:	623-849-3811
Fax Number	:	623-849-5221

Provider Business Practice Location Address
First Line	:	15000 N 83RD AVE UNIT 200
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-2002
Country	:	US
Telephone Number	:	623-849-3811
Fax Number	:	623-849-5221

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

Provider Enumeration Date	:	08/12/2024
Last Update Date	:	08/13/2025

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