Healthcare Provider Details

I. General information

NPI: 1588559892
Provider Name (Legal Business Name): LAUREN MARIE EVANS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CIVIC CENTER LN
LAKE HAVASU CITY AZ
86403-5683
US

IV. Provider business mailing address

1750 MCCULLOCH BLVD N UNIT 84
LAKE HAVASU CITY AZ
86405-5005
US

V. Phone/Fax

Practice location:
  • Phone: 928-855-8185
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number324992
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number324992
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: