Provider Demographics
NPI:1477960961
Name:BROCKETT, LAUREN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BROCKETT
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 1:3500 LAKESIDE CT
Mailing Address - Street 2:SUITE #101
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4829
Mailing Address - Country:US
Mailing Address - Phone:775-786-6880
Mailing Address - Fax:
Practice Address - Street 1:3500 LAKESIDE CT
Practice Address - Street 2:SUITE #101
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4829
Practice Address - Country:US
Practice Address - Phone:775-786-6880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner