Provider Demographics
NPI:1568752350
Name:BODENHAMER, LAUREN TAYLOR (NP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:TAYLOR
Last Name:BODENHAMER
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 1:3681 CYPRESS CIR
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-9038
Mailing Address - Country:US
Mailing Address - Phone:251-223-6069
Mailing Address - Fax:
Practice Address - Street 1:101 E 15TH AVE
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-3501
Practice Address - Country:US
Practice Address - Phone:251-962-1250
Practice Address - Fax:251-967-7832
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-114933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily