MEDICARE: LAUREN OBENLANDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	1-127045	AL
2	363LG0600X	Gerontology Nurse Practitioner	1-127045	AL

General Provider Information

NPI Number	:	1023412566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN OBENLANDER

Provider Business Mailing Address
First Line	:	2202 JORDAN RD SW STE 300
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-3693
Country	:	US
Telephone Number	:	256-844-2911
Fax Number	:

Provider Business Practice Location Address
First Line	:	2202 JORDAN RD SW STE 300
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-3693
Country	:	US
Telephone Number	:	256-844-2911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2014
Last Update Date	:	10/13/2014

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Directions to “ LAUREN OBENLANDER ” Practice Location

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