Provider Demographics
NPI:1508431008
Name:LAUREN KIRSTEN, LLC
Entity Type:Organization
Organization Name:LAUREN KIRSTEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-447-7274
Mailing Address - Street 1:1030 TIDEWATER SHORES LOOP UNIT 201
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1379
Mailing Address - Country:US
Mailing Address - Phone:941-757-3339
Mailing Address - Fax:941-757-3338
Practice Address - Street 1:5207 26TH ST W STE 102
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-2203
Practice Address - Country:US
Practice Address - Phone:941-757-3339
Practice Address - Fax:941-757-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date: