Provider Demographics
NPI:1972551083
Name:ALDERDICE, LAUREN THERESA (APRN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:THERESA
Last Name:ALDERDICE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15301 TYLER FOOTE RD
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9318
Mailing Address - Country:US
Mailing Address - Phone:530-292-3478
Mailing Address - Fax:530-292-4296
Practice Address - Street 1:15301 TYLER FOOTE RD
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-9318
Practice Address - Country:US
Practice Address - Phone:530-292-3478
Practice Address - Fax:530-292-4296
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN35330163W00000X
HIAPRN202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIS62822Medicare UPIN
HI101978Medicare PIN