Healthcare Provider Details

I. General information

NPI: 1487041976
Provider Name (Legal Business Name): LAUREN ERICKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 DONAGHEY AVE
CONWAY AR
72035-5001
US

IV. Provider business mailing address

2010 RICH SMITH LN APT 618
CONWAY AR
72032-4063
US

V. Phone/Fax

Practice location:
  • Phone: 720-218-7603
  • Fax:
Mailing address:
  • Phone: 720-218-7603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number537
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: