Healthcare Provider Details

I. General information

NPI: 1760168942
Provider Name (Legal Business Name): LAUREN ANNE GARDNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9441 HURON ST
THORNTON CO
80260-5426
US

IV. Provider business mailing address

PO BOX 7702
LOVELAND CO
80537-0702
US

V. Phone/Fax

Practice location:
  • Phone: 719-415-3092
  • Fax: 195-451-1829
Mailing address:
  • Phone: 970-663-2742
  • Fax: 970-667-0847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0998771-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: