MEDICARE: LAUREN ROSE EIMERS M.S.

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	170300000X	Genetic Counselor (M.S.)	80039253602	UT

General Provider Information

NPI Number	:	1992144356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ROSE EIMERS M.S.

Provider Business Mailing Address
First Line	:	50 N MEDICAL DR RM 2165
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-1204
Country	:	US
Telephone Number	:	801-585-3375
Fax Number	:	801-585-5696

Provider Business Practice Location Address
First Line	:	50 N MEDICAL DR RM 2165
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-1204
Country	:	US
Telephone Number	:	801-585-3375
Fax Number	:	801-585-5696

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

Provider Enumeration Date	:	06/19/2013
Last Update Date	:	06/19/2013

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