Provider Demographics
NPI:1285204537
Name:HOPPER, LAURYN ELIZABETH
Entity type:Individual
Prefix:MISS
First Name:LAURYN
Middle Name:ELIZABETH
Last Name:HOPPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURYN
Other - Middle Name:ELIZABETH
Other - Last Name:RUTHERFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2880 E SHEPHERD AVE APT 155
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3997
Mailing Address - Country:US
Mailing Address - Phone:602-309-4351
Mailing Address - Fax:
Practice Address - Street 1:2880 E SHEPHERD AVE APT 155
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3997
Practice Address - Country:US
Practice Address - Phone:602-309-4351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA95001973367500000X
CA95001973207L00000X
AZ249094163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty