Provider Demographics
NPI:1790203487
Name:OBERG, LAUREN SILLERY (FNP-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:SILLERY
Last Name:OBERG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:SILLERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:810 LAKE FOREST PASS
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2582
Mailing Address - Country:US
Mailing Address - Phone:478-320-1929
Mailing Address - Fax:
Practice Address - Street 1:1942 BEAVER RUIN RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-3828
Practice Address - Country:US
Practice Address - Phone:770-674-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA205546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily