Healthcare Provider Details

I. General information

NPI: 1144125113
Provider Name (Legal Business Name): LAUREN DIVIRGILIO AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 FARMING CREEK DR
SIMPSONVILLE SC
29680-6535
US

IV. Provider business mailing address

207 FARMING CREEK DR
SIMPSONVILLE SC
29680-6535
US

V. Phone/Fax

Practice location:
  • Phone: 708-790-6538
  • Fax:
Mailing address:
  • Phone: 708-790-6538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number32917
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: