Provider Demographics
NPI:1932886231
Name:ROUSH, LAUREN MICKELLE (APRN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MICKELLE
Last Name:ROUSH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MICKELLE
Other - Last Name:BOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1845 W CANYON VIEW DR APT 708
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5898
Mailing Address - Country:US
Mailing Address - Phone:817-917-8308
Mailing Address - Fax:
Practice Address - Street 1:385 N 3050 E
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-9003
Practice Address - Country:US
Practice Address - Phone:435-251-2630
Practice Address - Fax:435-627-0316
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10224272-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner