Provider Demographics
NPI:1851862411
Name:GAUDET, LAUREN RAE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:RAE
Last Name:GAUDET
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 1:60 WATER ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-4110
Mailing Address - Country:US
Mailing Address - Phone:978-712-0411
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR STE 435F
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6132
Practice Address - Country:US
Practice Address - Phone:978-712-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA254145174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN