Healthcare Provider Details

I. General information

NPI: 1134679608
Provider Name (Legal Business Name): LAUREN CHRISTINE WILSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN WILSON MACE CNM

II. Dates (important events)

Enumeration Date: 10/09/2016
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 S MAIN ST
CONCORD NH
03301-4817
US

IV. Provider business mailing address

38 S MAIN ST
CONCORD NH
03301-4817
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-2739
  • Fax: 603-228-6255
Mailing address:
  • Phone: 603-225-2739
  • Fax: 978-834-8077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM03681
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number087104-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: