Healthcare Provider Details

I. General information

NPI: 1922865187
Provider Name (Legal Business Name): LAUREN MARIENAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W BROWN RD STE 1011
MESA AZ
85201-3222
US

IV. Provider business mailing address

560 W BROWN RD STE 1011
MESA AZ
85201-3222
US

V. Phone/Fax

Practice location:
  • Phone: 480-712-6583
  • Fax:
Mailing address:
  • Phone: 480-712-6583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number230815
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2023207827
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: