Healthcare Provider Details

I. General information

NPI: 1063855393
Provider Name (Legal Business Name): LAUREN BETH FIRST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11154 HURON ST STE 212
NORTHGLENN CO
80234-2329
US

IV. Provider business mailing address

1000 REMINGTON BLVD STE 100
BOLINGBROOK IL
60440-4707
US

V. Phone/Fax

Practice location:
  • Phone: 303-920-5161
  • Fax:
Mailing address:
  • Phone: 630-914-2468
  • Fax: 630-914-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0003549
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: