Healthcare Provider Details

I. General information

NPI: 1124592779
Provider Name (Legal Business Name): LAUREN MICHELLE GOVER APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVE STE 902
ALEXANDRIA VA
22304-1306
US

IV. Provider business mailing address

13141 LEXINGTON SUMMIT ST
ORLANDO FL
32828-4310
US

V. Phone/Fax

Practice location:
  • Phone: 703-370-4300
  • Fax: 703-832-0050
Mailing address:
  • Phone: 407-864-2921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number11000991
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN11000991
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number0024186534
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: