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General NPI Number Information
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NPI Number | 1063138204
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Entity Type | Individual
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Provider Name | LAUREN DOUGLAS FNP
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Gender | Female
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Dates
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Enumeration Date | 10/19/2022
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 7525 E BROADWAY RD STE 9
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City | MESA
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State | AZ
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Zip | 85208-1156
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Country | US
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Telephone | 480-786-5000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20610
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City | MESA
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State | AZ
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Zip | 85277-0610
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Country | US
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Telephone | 833-584-1347
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 284981
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 208245
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License Number State | AZ
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