MEDICARE: MRS. LAUREN DANIELLE LANCE APRN

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	R105246	AR
2	363LP2300X	Primary Care Nurse Practitioner	212492	AR

General Provider Information

NPI Number	:	1982228995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREN DANIELLE LANCE APRN

Provider Business Mailing Address
First Line	:	6217 MERRELL DR
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72404-7681
Country	:	US
Telephone Number	:	870-930-8117
Fax Number	:

Provider Business Practice Location Address
First Line	:	1507 LINWOOD DR
Second Line	:
City	:	PARAGOULD
State	:	AR
Zip	:	72450-5818
Country	:	US
Telephone Number	:	870-239-8102
Fax Number	:

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

Provider Enumeration Date	:	06/04/2020
Last Update Date	:	07/16/2020

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