Provider Demographics
NPI:1346471760
Name:WILSON, LAUREN ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:WILSON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:ANESTHESIA DEPARTMENT - YAMINS 219
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-3364
Mailing Address - Fax:617-667-5013
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:ANESTHESIA DEPARTMENT - YAMINS 219
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-3364
Practice Address - Fax:617-667-5013
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2016-09-30
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Provider Licenses
StateLicense IDTaxonomies
MARN280612363LW0102X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health