=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184334922
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN NICOLE SHEWMAN FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2022
-----------------------------------------------------
Last Update Date | 12/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 392 ROCHESTER CROSSING DRIVE
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46975-7034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-325-5192
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 871 E MACY GILEAD RD
-----------------------------------------------------
City | MACY
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46951-7776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-513-1193
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 71013318A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------