Provider Demographics
NPI:1639558422
Name:SMITH, LAUREN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:SMITH
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 1:208 E PINE
Mailing Address - Street 2:
Mailing Address - City:WESTPHALIA
Mailing Address - State:MI
Mailing Address - Zip Code:48894-9815
Mailing Address - Country:US
Mailing Address - Phone:517-898-5491
Mailing Address - Fax:
Practice Address - Street 1:208 E PINE
Practice Address - Street 2:
Practice Address - City:WESTPHALIA
Practice Address - State:MI
Practice Address - Zip Code:48894-9815
Practice Address - Country:US
Practice Address - Phone:517-898-5491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5KNQ04247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other