Provider Demographics
NPI:1982228995
Name:LANCE, LAUREN DANIELLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:DANIELLE
Last Name:LANCE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:POAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, NMTCB, ARRT(R)
Mailing Address - Street 1:6217 MERRELL DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-7681
Mailing Address - Country:US
Mailing Address - Phone:870-930-8117
Mailing Address - Fax:
Practice Address - Street 1:1507 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5818
Practice Address - Country:US
Practice Address - Phone:870-239-8102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR105246163W00000X
AR212492363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse