Healthcare Provider Details

I. General information

NPI: 1609371632
Provider Name (Legal Business Name): LAUREN ELIZABETH GNAGY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 HOSPITAL LN STE 110
DANVILLE IN
46122-2600
US

IV. Provider business mailing address

112 HOSPITAL LN STE 110
DANVILLE IN
46122-2600
US

V. Phone/Fax

Practice location:
  • Phone: 317-745-8790
  • Fax: 317-745-8793
Mailing address:
  • Phone: 317-745-8790
  • Fax: 317-745-8793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01082850A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01082850A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116034939
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number01082850A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: