Provider Demographics
NPI:1073947354
Name:ELLISON, LAUREN DIANE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:DIANE
Last Name:ELLISON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-4119
Mailing Address - Country:US
Mailing Address - Phone:832-799-0908
Mailing Address - Fax:
Practice Address - Street 1:14201 E SAM HOUSTON PKWY N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-6291
Practice Address - Country:US
Practice Address - Phone:281-436-8895
Practice Address - Fax:281-436-8899
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX767546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily