Provider Demographics
NPI:1518651058
Name:EIDE, LAUREN PEARL (FNP-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:PEARL
Last Name:EIDE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ROWE ST STE 500
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3228
Mailing Address - Country:US
Mailing Address - Phone:781-979-3800
Mailing Address - Fax:781-662-2778
Practice Address - Street 1:50 ROWE ST STE 500
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3228
Practice Address - Country:US
Practice Address - Phone:781-979-3800
Practice Address - Fax:781-662-2778
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2322043363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner