Provider Demographics
NPI:1902376999
Name:PRANCE, LAUREN (CRNP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:PRANCE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 1ST AVE N UNIT 3M135
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-1865
Mailing Address - Country:US
Mailing Address - Phone:120-554-5509
Mailing Address - Fax:205-769-1405
Practice Address - Street 1:2134 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1155
Practice Address - Country:US
Practice Address - Phone:251-236-4026
Practice Address - Fax:251-270-4257
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-163141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL174613Medicaid
AL102G705836OtherMEDICARE