Healthcare Provider Details

I. General information

NPI: 1346948882
Provider Name (Legal Business Name): LAUREN E BROADBENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC10 5610 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

17450 GROVELAND PL
WAYZATA MN
55391-2880
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4161
  • Fax: 505-272-2776
Mailing address:
  • Phone: 952-687-1032
  • Fax:

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 State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRS2025-0138
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: