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General NPI Number Information
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NPI Number | 1689631590
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Entity Type | Individual
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Provider Name | LAUREN MARIE PHOENIX CRNA
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Gender | Female
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 150 N EAGLE CREEK ST. JOES EAST
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City | LEXINGTON
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State | KY
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Zip | 40509
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Country | US
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Telephone | 859-967-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 19037 B DRIVE N
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City | MARSHALL
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State | MI
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Zip | 49068
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Country | US
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Telephone | 517-240-9748
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4704164418
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License Number State | MI
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