Healthcare Provider Details

I. General information

NPI: 1912590357
Provider Name (Legal Business Name): LAUREN A ROBERTS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 02/17/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W APACHE ST
FARMINGTON NM
87401-5526
US

IV. Provider business mailing address

700 W APACHE ST
FARMINGTON NM
87401-5526
US

V. Phone/Fax

Practice location:
  • Phone: 505-599-8602
  • Fax: 855-851-4400
Mailing address:
  • Phone: 505-599-8602
  • Fax: 855-851-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR58310
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: