Healthcare Provider Details

I. General information

NPI: 1376327247
Provider Name (Legal Business Name): LAUREN BLAIR FONTENOT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE KAISER PLAZA 17 BAYSIDE
OAKLAND CA
94612-3610
US

IV. Provider business mailing address

13386 AIRLINE HWY STE B
GONZALES LA
70737-6601
US

V. Phone/Fax

Practice location:
  • Phone: 650-301-4535
  • Fax:
Mailing address:
  • Phone: 225-310-1201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number95126679
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029736
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number78163
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number878253
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10026051
License Number StateOR
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number235187
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: