Provider Demographics
NPI:1346645926
Name:SOBOTKA, LAUREN PALANK (MSN, RN, CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:PALANK
Last Name:SOBOTKA
Suffix:
Gender:F
Credentials:MSN, RN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Mailing Address - Street 1:3419 EDWARDS LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3419 EDWARDS LN
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-2912
Practice Address - Country:US
Practice Address - Phone:301-814-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-25
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR224646363LP0200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
20142571OtherPEDIATRIC NURSING CERTIFICATION BOARD
MDR224646OtherMARYLAND BOARD OF NURSING
MD251205000Medicaid
MD196100160Medicaid