Provider Demographics
NPI:1114413911
Name:MERTES, LAUREN (RN)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MERTES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:EHLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:3276 9TH ST W APT D
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-7835
Mailing Address - Country:US
Mailing Address - Phone:470-309-8305
Mailing Address - Fax:
Practice Address - Street 1:2101 ELM ST N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2417
Practice Address - Country:US
Practice Address - Phone:701-239-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDL16233164W00000X
NDR55701163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse