Provider Demographics
NPI:1093488595
Name:PIZARRO, LAUREN MARIE (APRN, RN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:PIZARRO
Suffix:
Gender:F
Credentials:APRN, RN
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3286 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-0724
Mailing Address - Country:US
Mailing Address - Phone:208-899-9996
Mailing Address - Fax:
Practice Address - Street 1:5926 FASHION POINT DR
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4541
Practice Address - Country:US
Practice Address - Phone:208-899-9996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTTBD363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner