Healthcare Provider Details

I. General information

NPI: 1790327187
Provider Name (Legal Business Name): LAUREN ULRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 11/28/2024
Certification Date: 11/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2852 EYDE PKWY STE 175
EAST LANSING MI
48823-5378
US

IV. Provider business mailing address

2852 EYDE PKWY STE 175
EAST LANSING MI
48823-5378
US

V. Phone/Fax

Practice location:
  • Phone: 517-333-4600
  • Fax: 517-333-4996
Mailing address:
  • Phone: 517-333-4600
  • Fax: 517-333-4996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: