MEDICARE: LAUREN RAE CARREON

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1710878178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN RAE CARREON

Provider Business Mailing Address
First Line	:	2100 N MAIN ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-1183
Country	:	US
Telephone Number	:	915-241-4485
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 N MAIN ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-1183
Country	:	US
Telephone Number	:	915-241-4485
Fax Number	:

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

Provider Enumeration Date	:	07/14/2025
Last Update Date	:	07/14/2025

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Directions to “ LAUREN RAE CARREON ” Practice Location

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