Provider Demographics
NPI:1194265181
Name:RIORDAN, LAUREN (CPM, RN)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:RIORDAN
Suffix:
Gender:F
Credentials:CPM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 LAWRENCE RD
Mailing Address - Street 2:
Mailing Address - City:SHAFTSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05262-9463
Mailing Address - Country:US
Mailing Address - Phone:203-733-2869
Mailing Address - Fax:802-332-3269
Practice Address - Street 1:75 LAWRENCE RD
Practice Address - Street 2:
Practice Address - City:SHAFTSBURY
Practice Address - State:VT
Practice Address - Zip Code:05262-9463
Practice Address - Country:US
Practice Address - Phone:203-733-2869
Practice Address - Fax:802-332-3269
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT107.0128365176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife