MEDICARE: LAUREN ANN NELSON L.AC, LMT

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	171100000X	Acupuncturist	5402000294	MI

General Provider Information

NPI Number	:	1477365930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ANN NELSON L.AC, LMT

Provider Business Mailing Address
First Line	:	2815 MICHIGAN ST NE STE A
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-1266
Country	:	US
Telephone Number	:	616-855-7718
Fax Number	:

Provider Business Practice Location Address
First Line	:	2815 MICHIGAN ST NE STE A
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-1266
Country	:	US
Telephone Number	:	616-855-7718
Fax Number	:	616-855-2977

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

Provider Enumeration Date	:	01/22/2025
Last Update Date	:	01/22/2025

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