Healthcare Provider Details

I. General information

NPI: 1770198137
Provider Name (Legal Business Name): LAUREN ELIZABETH CIESLAK FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN ELIZABETH MEHRER

II. Dates (important events)

Enumeration Date: 09/12/2020
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 OAKWOOD BLVD STE 1011N
DEARBORN MI
48124-4089
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 313-438-7986
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704279690
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: