Provider Demographics
NPI:1437526068
Name:MONGOLD, LAUREN (NP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MONGOLD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 WALNUT BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:FISHER
Mailing Address - State:WV
Mailing Address - Zip Code:26818-4067
Mailing Address - Country:US
Mailing Address - Phone:304-348-2005
Mailing Address - Fax:
Practice Address - Street 1:22347 NORTHWESTERN PIKE
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-6343
Practice Address - Country:US
Practice Address - Phone:304-822-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN79883-NP-C363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner