Healthcare Provider Details

I. General information

NPI: 1437008257
Provider Name (Legal Business Name): LAUREN RAQUEL WEGNER RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 SCOTTS VALLEY DR STE B
SCOTTS VALLEY CA
95066-3465
US

IV. Provider business mailing address

5610 SCOTTS VALLEY DR STE
SCOTTS VALLEY CA
95066-3465
US

V. Phone/Fax

Practice location:
  • Phone: 408-221-8117
  • Fax:
Mailing address:
  • Phone: 408-221-8117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95415887
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: