MEDICARE: LAUREN TRACY WILLS ZEFFARO FNP-BC

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	95015854	CA

General Provider Information

NPI Number	:	1811590813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN TRACY WILLS ZEFFARO FNP-BC

Provider Business Mailing Address
First Line	:	2092 LAKE TAHOE BLVD STE 500
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-6429
Country	:	US
Telephone Number	:	530-600-2186
Fax Number	:

Provider Business Practice Location Address
First Line	:	2092 LAKE TAHOE BLVD STE 500
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-6429
Country	:	US
Telephone Number	:	530-600-1960
Fax Number	:

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

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	11/20/2020

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