Healthcare Provider Details

I. General information

NPI: 1356770697
Provider Name (Legal Business Name): LAUREN GAINES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4327 GOLDEN CENTER DR
PLACERVILLE CA
95667-6287
US

IV. Provider business mailing address

4327 GOLDEN CENTER DR
PLACERVILLE CA
95667-6287
US

V. Phone/Fax

Practice location:
  • Phone: 530-621-7700
  • Fax: 530-621-7713
Mailing address:
  • Phone: 530-621-7700
  • Fax: 530-621-7713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR882830
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5006888
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: