MEDICARE: LAUREN MCCONNELL

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	363L00000X	Nurse Practitioner	R197797	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R1977797	OTHER	MD	AG-ACNP

General Provider Information

NPI Number	:	1679284194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN MCCONNELL

Provider Business Mailing Address
First Line	:	2927 ODONNELL ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-4823
Country	:	US
Telephone Number	:	443-417-8016
Fax Number	:

Provider Business Practice Location Address
First Line	:	2927 ODONNELL ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-4823
Country	:	US
Telephone Number	:	443-417-8016
Fax Number	:

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

Provider Enumeration Date	:	12/06/2022
Last Update Date	:	12/06/2022

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Directions to “ LAUREN MCCONNELL ” Practice Location

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