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General NPI Number Information
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NPI Number | 1508431008
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Entity Type | Organization
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Legal Business Name | LAUREN KIRSTEN, LLC
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 5207 26TH ST W STE 102
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City | BRADENTON
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State | FL
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Zip | 34207-2203
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Country | US
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Telephone | 941-757-3339
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Fax | 941-757-3338
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Provider Business Mailing Address
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Address Line | 1030 TIDEWATER SHORES LOOP UNIT 201
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City | BRADENTON
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State | FL
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Zip | 34208-1379
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Country | US
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Telephone | 941-757-3339
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Fax | 941-757-3338
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOEL PUNG
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Credential |
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Telephone | 941-447-7274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 342000000X
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Taxonomy Name | Transportation Network Company
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License Number |
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License Number State |
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