Provider Demographics
NPI:1851926067
Name:TANGREDI, LAUREN KIP (RN)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:KIP
Last Name:TANGREDI
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 1:3448 VAN WIE DR E
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-8910
Mailing Address - Country:US
Mailing Address - Phone:315-491-7405
Mailing Address - Fax:
Practice Address - Street 1:3448 VAN WIE DR E
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-8910
Practice Address - Country:US
Practice Address - Phone:315-491-7943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-08
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY484253-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse