Provider Demographics
NPI:1376000414
Name:MARGOLIS, LAUREN CECILE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:CECILE
Last Name:MARGOLIS
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 1:412 NE FORD ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4608
Mailing Address - Country:US
Mailing Address - Phone:503-434-7525
Mailing Address - Fax:503-472-9731
Practice Address - Street 1:412 NE FORD ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4608
Practice Address - Country:US
Practice Address - Phone:503-434-7525
Practice Address - Fax:503-472-9731
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201706933163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty