Healthcare Provider Details

I. General information

NPI: 1326493503
Provider Name (Legal Business Name): LAUREN CANTWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 E PRATER WAY
SPARKS NV
89434-9641
US

IV. Provider business mailing address

1525 WEST CYPRESS CREEK ROAD
FORT LAUDERDALE FL
33309-1831
US

V. Phone/Fax

Practice location:
  • Phone: 775-331-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA160495
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number036.167631
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number21142
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number21141
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: