Provider Demographics
NPI:1710051438
Name:OUTLAND, LAUREN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:OUTLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:OUTLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1000 E VICTORIA ST
Mailing Address - Street 2:SCHOOL OF NURSING
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90747-0001
Mailing Address - Country:US
Mailing Address - Phone:310-222-3714
Mailing Address - Fax:
Practice Address - Street 1:1000 E VICTORIA ST
Practice Address - Street 2:SCHOOL OF NURSING
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90747-0001
Practice Address - Country:US
Practice Address - Phone:310-222-3714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA401360163W00000X
CA18779363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163W00000XNursing Service ProvidersRegistered Nurse