Provider Demographics
NPI:1326057092
Name:BLANCHARD, LAUREN BOYD (CNFP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:BOYD
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:CNFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 TELEGRAPH AVE
Mailing Address - Street 2:SUITE 2102
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3239
Mailing Address - Country:US
Mailing Address - Phone:510-286-8175
Mailing Address - Fax:510-286-8158
Practice Address - Street 1:3100 TELEGRAPH AVE
Practice Address - Street 2:SUITE 2102
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3239
Practice Address - Country:US
Practice Address - Phone:510-286-8175
Practice Address - Fax:510-286-8158
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR48284363LF0000X
CA21484363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM28958519Medicaid
NM343517500Medicare ID - Type Unspecified
NMP75931Medicare UPIN