Healthcare Provider Details

I. General information

NPI: 1821741943
Provider Name (Legal Business Name): LAUREN ALANA PEVNICK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11645 WILSHIRE BLVD STE 605
LOS ANGELES CA
90025-6842
US

IV. Provider business mailing address

4151 REDWOOD AVE APT 413
LOS ANGELES CA
90066-5632
US

V. Phone/Fax

Practice location:
  • Phone: 424-644-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number95250381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: