Healthcare Provider Details

I. General information

NPI: 1447792403
Provider Name (Legal Business Name): LAUREN KRASNER WALSH MS, AT, ATC, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN KRASNER

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W THOMAS RD STE 302
PHOENIX AZ
85013-4407
US

IV. Provider business mailing address

920 E GLENMERE DR
CHANDLER AZ
85225-6429
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-4762
  • Fax:
Mailing address:
  • Phone: 520-488-8592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1332
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: