MEDICARE: LAUREN ROBERTS

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	2255A2300X	Athletic Trainer	AT-231	HI
2	390200000X	Student in an Organized Health Care Education/Training Program	AT-231	HI

General Provider Information

NPI Number	:	1962892000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ROBERTS

Provider Business Mailing Address
First Line	:	3619 KILAUEA AVE
Second Line	:	A
City	:	HONOLULU
State	:	HI
Zip	:	96816-2342
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3619 KILAUEA AVE
Second Line	:	A
City	:	HONOLULU
State	:	HI
Zip	:	96816-2342
Country	:	US
Telephone Number	:	920-393-0624
Fax Number	:

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

Provider Enumeration Date	:	01/28/2015
Last Update Date	:	01/28/2015

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Directions to “ LAUREN ROBERTS ” Practice Location

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