Provider Demographics
NPI:1649621178
Name:FOUNTAIN, LAUREN (CNM)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:FOUNTAIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3070 11TH AVENUE DR SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-8336
Mailing Address - Country:US
Mailing Address - Phone:828-466-7196
Mailing Address - Fax:828-466-7194
Practice Address - Street 1:3070 11TH AVENUE DR SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-8336
Practice Address - Country:US
Practice Address - Phone:828-466-7194
Practice Address - Fax:828-466-7194
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife