Provider Demographics
NPI:1356770697
Name:GAINES, LAUREN (FNP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GAINES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4327 GOLDEN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6287
Mailing Address - Country:US
Mailing Address - Phone:530-621-7700
Mailing Address - Fax:530-621-7713
Practice Address - Street 1:4327 GOLDEN CENTER DR
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6287
Practice Address - Country:US
Practice Address - Phone:530-621-7700
Practice Address - Fax:530-621-7713
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR882830363LF0000X
NC5006888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC363LF0000XOtherTAXONOMY