Provider Demographics
NPI:1245058379
Name:WHITEFORD, LAUREN (EDD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:WHITEFORD
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10648 JACKSON DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-4425
Mailing Address - Country:US
Mailing Address - Phone:612-473-7733
Mailing Address - Fax:
Practice Address - Street 1:10648 JACKSON DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-4425
Practice Address - Country:US
Practice Address - Phone:612-473-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No253Z00000XAgenciesIn Home Supportive Care