Provider Demographics
NPI:1710431218
Name:BROCK, LAUREN ELAINE
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ELAINE
Last Name:BROCK
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 1:415 BARDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4714
Mailing Address - Country:US
Mailing Address - Phone:423-883-4719
Mailing Address - Fax:
Practice Address - Street 1:415 BARDWOOD LN
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4714
Practice Address - Country:US
Practice Address - Phone:423-883-4719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator