MEDICARE: LAUREN MALEY CORONA RN

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	163W00000X	Registered Nurse	8412726-3102	UT

General Provider Information

NPI Number	:	1861872624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN MALEY CORONA RN

Provider Business Mailing Address
First Line	:	950 N CUTLER DR
Second Line	:	APT 533
City	:	NORTH SALT LAKE
State	:	UT
Zip	:	84054-5042
Country	:	US
Telephone Number	:	240-701-4773
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 N CUTLER DR
Second Line	:	APT 533
City	:	NORTH SALT LAKE
State	:	UT
Zip	:	84054-5042
Country	:	US
Telephone Number	:	240-701-4773
Fax Number	:

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

Provider Enumeration Date	:	06/05/2015
Last Update Date	:	06/05/2015

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