Provider Demographics
NPI:1396298006
Name:DAMBOLD, LAUREN MAE (NP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MAE
Last Name:DAMBOLD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6021 MORRISS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3762
Mailing Address - Country:US
Mailing Address - Phone:214-247-6757
Mailing Address - Fax:877-370-4745
Practice Address - Street 1:6021 MORRISS RD STE 100
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3762
Practice Address - Country:US
Practice Address - Phone:214-247-6757
Practice Address - Fax:877-370-4745
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP131506363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty