Healthcare Provider Details

I. General information

NPI: 1962179697
Provider Name (Legal Business Name): LAUREN CARROLL MUNSELL DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 BLUEGRASS CIR
CHEYENNE WY
82009-7328
US

IV. Provider business mailing address

3521 SHAWNEE ST
CHEYENNE WY
82001-8548
US

V. Phone/Fax

Practice location:
  • Phone: 307-635-3500
  • Fax:
Mailing address:
  • Phone: 719-321-0973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number45608
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: