Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | RN177811 | AZ |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP11301 | AZ |
NPI | 1609361492 |
---|---|
Provider Name | Lauren Michelle Nivison |
First Address | Phoenix, AZ 85016-6512 |
Second Address | Phoenix, AZ 85016-6512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2018 |
Last Update Date | 18/08/2021 |