Healthcare Provider Details

I. General information

NPI: 1942479613
Provider Name (Legal Business Name): LAUREN D. RICHARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 CONKEY ST 2ND FLOOR
HAMMOND IN
46324-1100
US

IV. Provider business mailing address

534 CONKEY ST 2ND FLOOR
HAMMOND IN
46324-1100
US

V. Phone/Fax

Practice location:
  • Phone: 219-933-7111
  • Fax: 219-933-6657
Mailing address:
  • Phone: 219-933-7111
  • Fax: 219-933-6657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28171444A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: