Provider Demographics
NPI:1780199398
Name:ULRICH, LAUREN ECCLES (RN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ECCLES
Last Name:ULRICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6394 FAIRWEATHER DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-2286
Mailing Address - Country:US
Mailing Address - Phone:801-668-1234
Mailing Address - Fax:
Practice Address - Street 1:6394 FAIRWEATHER DRIVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-9951
Practice Address - Country:US
Practice Address - Phone:801-668-1234
Practice Address - Fax:801-668-1234
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7657377-3102163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health