Healthcare Provider Details

I. General information

NPI: 1831689199
Provider Name (Legal Business Name): LAUREN ELIZABETH GUNDERSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2018
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE
SPOKANE WA
99204-2307
US

IV. Provider business mailing address

9 E 9TH AVE STE 212
SPOKANE WA
99202-1209
US

V. Phone/Fax

Practice location:
  • Phone: 509-398-9993
  • Fax:
Mailing address:
  • Phone: 406-697-5154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number2021016740
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number61531002
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: