Provider Demographics
NPI:1073821724
Name:PAK, LAUREN L (FNP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:L
Last Name:PAK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 CENTER AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4640
Mailing Address - Country:US
Mailing Address - Phone:925-313-6250
Mailing Address - Fax:
Practice Address - Street 1:597 CENTER AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4640
Practice Address - Country:US
Practice Address - Phone:925-313-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA752728163WC1500X
CA20193363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health