MEDICARE: MRS. LAUREN TAYLOR BODENHAMER NP

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	363LF0000X	Family Nurse Practitioner	1-114933	AL

General Provider Information

NPI Number	:	1568752350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREN TAYLOR BODENHAMER NP

Provider Business Mailing Address
First Line	:	3681 CYPRESS CIR
Second Line	:
City	:	GULF SHORES
State	:	AL
Zip	:	36542-9038
Country	:	US
Telephone Number	:	251-223-6069
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 E 15TH AVE
Second Line	:
City	:	GULF SHORES
State	:	AL
Zip	:	36542-3501
Country	:	US
Telephone Number	:	251-962-1250
Fax Number	:	251-967-7832

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

Provider Enumeration Date	:	04/13/2011
Last Update Date	:	11/13/2020

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