Healthcare Provider Details

I. General information

NPI: 1679236897
Provider Name (Legal Business Name): LAUREN FOTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W WILLOW ST
LAFAYETTE LA
70501-2837
US

IV. Provider business mailing address

220 W WILLOW ST
LAFAYETTE LA
70501-2837
US

V. Phone/Fax

Practice location:
  • Phone: 337-262-5616
  • Fax:
Mailing address:
  • Phone: 337-262-5616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN108761
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: