Healthcare Provider Details

I. General information

NPI: 1346496411
Provider Name (Legal Business Name): LAUREN DONAGHER WATSON APN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN MARIE DONAGHER APN, CNP

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E SCHILLER ST SUITE 318
ELMHURST IL
60126
US

IV. Provider business mailing address

110 E SCHILLER ST SUITE 318
ELMHURST IL
60126
US

V. Phone/Fax

Practice location:
  • Phone: 630-832-1775
  • Fax: 630-832-3078
Mailing address:
  • Phone: 630-832-1775
  • Fax: 630-832-3078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209006981
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209.006981
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: