Provider Demographics
NPI:1134679608
Name:WILSON, LAUREN CHRISTINE (CNM)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:CHRISTINE
Last Name:WILSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:WILSON
Other - Last Name:MACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:38 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4817
Mailing Address - Country:US
Mailing Address - Phone:603-225-2739
Mailing Address - Fax:978-834-8077
Practice Address - Street 1:38 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4817
Practice Address - Country:US
Practice Address - Phone:603-225-2739
Practice Address - Fax:603-228-6255
Is Sole Proprietor?:No
Enumeration Date:2016-10-09
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNM03681367A00000X
NH087104-21363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife