Provider Demographics
NPI:1376327247
Name:FONTENOT, LAUREN BLAIR (FNP)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:BLAIR
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13386 AIRLINE HWY STE B
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-6601
Mailing Address - Country:US
Mailing Address - Phone:225-310-1201
Mailing Address - Fax:
Practice Address - Street 1:ONE KAISER PLAZA
Practice Address - Street 2:17 BAYSIDE
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3610
Practice Address - Country:US
Practice Address - Phone:650-301-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95126679163WI0600X
CA95029736363LF0000X
NM78163363LF0000X
NV878253363LF0000X
OR10026051363LF0000X
LA235187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WI0600XNursing Service ProvidersRegistered NurseInfection Control