Provider Demographics
NPI:1689388241
Name:POVOLI, LAUREN (NP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:POVOLI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:477 N EL CAMINO REAL STE A100
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1329
Mailing Address - Country:US
Mailing Address - Phone:760-943-9111
Mailing Address - Fax:
Practice Address - Street 1:477 N EL CAMINO REAL STE A100
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1329
Practice Address - Country:US
Practice Address - Phone:760-943-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021896363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily