Healthcare Provider Details

I. General information

NPI: 1255097739
Provider Name (Legal Business Name): LAUREN MICHELLE WARNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 FAIRFIELD AVE
SHREVEPORT LA
71101-4443
US

IV. Provider business mailing address

PO BOX 52903
SHREVEPORT LA
71135-2903
US

V. Phone/Fax

Practice location:
  • Phone: 318-626-2777
  • Fax:
Mailing address:
  • Phone: 318-751-6597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN153448
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: