Provider Demographics
NPI:1275363368
Name:TITUS, LAUREN (CNA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:TITUS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1852 RIDGEMONT CIR
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-3471
Mailing Address - Country:US
Mailing Address - Phone:920-857-6008
Mailing Address - Fax:
Practice Address - Street 1:801 BRAXTON PL FL 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1415
Practice Address - Country:US
Practice Address - Phone:608-260-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI033075701312376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide