Provider Demographics
NPI:1457911786
Name:ANDERSON, LAUREN NICOLE (NP-C)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:NICOLE
Last Name:ANDERSON
Suffix:
Gender:
Credentials:NP-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:NICOLE
Other - Last Name:SHIVELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1512 WESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-6252
Mailing Address - Country:US
Mailing Address - Phone:304-685-8446
Mailing Address - Fax:
Practice Address - Street 1:1100 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5537
Practice Address - Country:US
Practice Address - Phone:877-381-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDF06191176363LF0000X
MARN10016876363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily