Healthcare Provider Details

I. General information

NPI: 1437881034
Provider Name (Legal Business Name): LAUREN RALPH PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S 7TH AVE STE 150
PHOENIX AZ
85007-4075
US

IV. Provider business mailing address

1201 S 7TH AVE STE 150
PHOENIX AZ
85007-4075
US

V. Phone/Fax

Practice location:
  • Phone: 602-415-7600
  • Fax:
Mailing address:
  • Phone: 602-415-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRNP277287
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: