Provider Demographics
NPI:1346496411
Name:WATSON, LAUREN DONAGHER (APN, CNP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:DONAGHER
Last Name:WATSON
Suffix:
Gender:F
Credentials:APN, CNP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:DONAGHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN, CNP
Mailing Address - Street 1:110 E SCHILLER ST
Mailing Address - Street 2:SUITE 318
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126
Mailing Address - Country:US
Mailing Address - Phone:630-832-1775
Mailing Address - Fax:630-832-3078
Practice Address - Street 1:110 E SCHILLER ST
Practice Address - Street 2:SUITE 318
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126
Practice Address - Country:US
Practice Address - Phone:630-832-1775
Practice Address - Fax:630-832-3078
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006981363LA2200X
IL209.006981363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206104Medicare UPIN