Provider Demographics
NPI:1164012076
Name:HEASLIP, LAUREN CONSTANCE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:CONSTANCE
Last Name:HEASLIP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 IVORY TRL SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6368
Mailing Address - Country:US
Mailing Address - Phone:678-756-6890
Mailing Address - Fax:
Practice Address - Street 1:3210 IVORY TRL SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-6368
Practice Address - Country:US
Practice Address - Phone:678-756-6890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula