Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 1-127045 | AL |
N | 363LG0600X | Nurse Practitioner - Gerontology | 1-127045 | AL |
NPI | 1023412566 |
---|---|
Provider Name | Lauren Obenlander |
First Address | Fort Payne, AL 35968-3693 |
Second Address | Fort Payne, AL 35968-3693 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2014 |
Last Update Date | 13/10/2014 |