Healthcare Provider Details

I. General information

NPI: 1780276576
Provider Name (Legal Business Name): LAUREN ASHLEY PAULSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CRESTLINE DR
FOREST VA
24551-1470
US

IV. Provider business mailing address

103 CRESTLINE DR
FOREST VA
24551-1470
US

V. Phone/Fax

Practice location:
  • Phone: 434-485-3530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024180212
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: