NPI 1063138204 · live from the CMS NPI Registry
Lauren Douglas, FNP
Nurse Practitioner in Mesa, AZ. National Provider Identifier 1063138204, active.
NPI record
| NPI | 1063138204 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner 363L00000X |
| Practice location | 7525 E Broadway Rd Ste 9, Mesa, AZ 85208 |
| Practice phone | 480-786-5000 |
| Mailing address | Po Box 20610, Mesa, AZ 85277 |
| Enumerated | October 19, 2022 |
| Last updated | May 30, 2023 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner primary | 363L00000X | 284981 (AZ) |
| Registered Nurse, General Practice | 163WG0000X | 208245 (AZ) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.