Healthcare Provider Details

I. General information

NPI: 1093674400
Provider Name (Legal Business Name): LAUREN KELLY GRENON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2026
Last Update Date: 01/21/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12176 GILHAM CT
GRASS VALLEY CA
95949-9788
US

IV. Provider business mailing address

12176 GILHAM CT
GRASS VALLEY CA
95949-9788
US

V. Phone/Fax

Practice location:
  • Phone: 530-277-1907
  • Fax:
Mailing address:
  • Phone: 530-277-1907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number95267984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: