Provider Demographics
NPI:1922824820
Name:BUSCH, LAUREN NICOLE (FDN-P)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:NICOLE
Last Name:BUSCH
Suffix:
Gender:F
Credentials:FDN-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 S 800 E
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-5037
Mailing Address - Country:US
Mailing Address - Phone:385-398-1333
Mailing Address - Fax:801-421-7353
Practice Address - Street 1:1428 S 800 E
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:UT
Practice Address - Zip Code:84664-5037
Practice Address - Country:US
Practice Address - Phone:302-897-3373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator