Provider Demographics
NPI:1104249903
Name:GONZALEZ, LAUREN (LPN)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 EUTAW ST
Mailing Address - Street 2:APT 1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:127 EUTAW ST
Practice Address - Street 2:APT 1
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-2546
Practice Address - Country:US
Practice Address - Phone:978-618-2878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN69494164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse