Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20950 N TATUM BLVD STE 380
PHOENIX AZ
85050-4258
US

IV. Provider business mailing address

20950 N TATUM BLVD STE 380
PHOENIX AZ
85050-4258
US

V. Phone/Fax

Practice location:
  • Phone: 480-626-7584
  • Fax:
Mailing address:
  • Phone: 480-712-6583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: