Healthcare Provider Details

I. General information

NPI: 1447717848
Provider Name (Legal Business Name): LAUREN MARIE VANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 02/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 GREENCASTLE RD
BURTONSVILLE MD
20866-1715
US

IV. Provider business mailing address

5330 DORSEY HALL DR
ELLICOTT CITY MD
21042-7831
US

V. Phone/Fax

Practice location:
  • Phone: 240-970-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number06273
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: