Healthcare Provider Details

I. General information

NPI: 1104113414
Provider Name (Legal Business Name): LAUREN DEBRUYN CNIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 12TH AVE S UNIT 306
NASHVILLE TN
37203-3367
US

IV. Provider business mailing address

PO BOX 24387
NASHVILLE TN
37202-4387
US

V. Phone/Fax

Practice location:
  • Phone: 615-928-6075
  • Fax: 615-457-1447
Mailing address:
  • Phone: 615-928-6075
  • Fax: 615-457-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: