Healthcare Provider Details

I. General information

NPI: 1578280327
Provider Name (Legal Business Name): LAUREN CREAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 BELLE TERRE RD 47
PORT JEFFERSON NY
11777
US

IV. Provider business mailing address

645 BELLE TERRE RD APT 47
PORT JEFFERSON NY
11777-1940
US

V. Phone/Fax

Practice location:
  • Phone: 631-637-0293
  • Fax:
Mailing address:
  • Phone: 631-637-0293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number344726
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: