MEDICARE: LAUREN LYELL RN

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	163WL0100X	Lactation Consultant (Registered Nurse)	RN197652	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN197652	OTHER	AZ	RN LICENSE NUMBER

General Provider Information

NPI Number	:	1184224917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN LYELL RN

Provider Business Mailing Address
First Line	:	1249 E TONTO LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024-1770
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1249 E TONTO LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024-1770
Country	:	US
Telephone Number	:	602-435-3877
Fax Number	:

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

Provider Enumeration Date	:	10/30/2020
Last Update Date	:	10/30/2020

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