Healthcare Provider Details

I. General information

NPI: 1366710030
Provider Name (Legal Business Name): LAUREN FRANCES KING REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3039 WILSON AVE APARTMENT 2
BRONX NY
10469-5104
US

IV. Provider business mailing address

3039 WILSON AVE APARTMENT 2
BRONX NY
10469-5104
US

V. Phone/Fax

Practice location:
  • Phone: 917-434-9353
  • Fax:
Mailing address:
  • Phone: 917-434-9353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number484224
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: