Healthcare Provider Details

I. General information

NPI: 1760768857
Provider Name (Legal Business Name): LAUREN GRIZZARD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N WILLOW AVE
COOKEVILLE TN
38501-2368
US

IV. Provider business mailing address

150 N WILLOW AVE
COOKEVILLE TN
38501-2368
US

V. Phone/Fax

Practice location:
  • Phone: 931-528-1485
  • Fax:
Mailing address:
  • Phone: 931-528-1485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16090
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: