Healthcare Provider Details

I. General information

NPI: 1104266337
Provider Name (Legal Business Name): LAUREN NICOLE ROWELL PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

4904 CAMINO VALLE TRL NW
ALBUQUERQUE NM
87120-4685
US

V. Phone/Fax

Practice location:
  • Phone: 52-651-7115
  • Fax:
Mailing address:
  • Phone: 704-614-0658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1659
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: