Provider Demographics
NPI:1376815753
Name:SHURSON, LAUREN (FNP-BC, RN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:SHURSON
Suffix:
Gender:F
Credentials:FNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 W FRYE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6273
Mailing Address - Country:US
Mailing Address - Phone:480-821-3600
Mailing Address - Fax:
Practice Address - Street 1:21300 N JOHN WAYNE PKWY STE 121
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-8978
Practice Address - Country:US
Practice Address - Phone:520-494-7045
Practice Address - Fax:480-857-2667
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN184560163W00000X
TN16319363LF0000X
AZAP10729363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse