Provider Demographics
NPI:1588049043
Name:SULLIVAN, LAUREN MARIE (FNP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:SCHAWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:571 TREVINO RDG
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3486
Mailing Address - Country:US
Mailing Address - Phone:859-412-6904
Mailing Address - Fax:
Practice Address - Street 1:571 TREVINO RDG
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3486
Practice Address - Country:US
Practice Address - Phone:859-412-6904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009575363LF0000X
OH025658363LF0000X
CO0002351363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily