Healthcare Provider Details

I. General information

NPI: 1053059899
Provider Name (Legal Business Name): LAUREN STRUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 MAIN ST
WATERVILLE ME
04901-6117
US

IV. Provider business mailing address

211 MAIN ST
WATERVILLE ME
04901-6117
US

V. Phone/Fax

Practice location:
  • Phone: 78-773-4002
  • Fax: 207-877-3401
Mailing address:
  • Phone: 78-773-4002
  • Fax: 207-877-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD29396
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberEC221031
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: