Healthcare Provider Details

I. General information

NPI: 1831693894
Provider Name (Legal Business Name): LAUREN NAMI CROUSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5603 DURALEIGH RD STE 111
RALEIGH NC
27612-2688
US

IV. Provider business mailing address

PO BOX 18563
RALEIGH NC
27619-8563
US

V. Phone/Fax

Practice location:
  • Phone: 919-791-0840
  • Fax: 919-791-0911
Mailing address:
  • Phone: 919-859-5955
  • Fax: 919-859-5659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2022-01020
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: