Provider Demographics
NPI:1962911107
Name:STACHURA, LAUREN ANNE
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANNE
Last Name:STACHURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 ANCIENT DR SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-4504
Mailing Address - Country:US
Mailing Address - Phone:616-745-7406
Mailing Address - Fax:
Practice Address - Street 1:2441 ANCIENT DR SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-4504
Practice Address - Country:US
Practice Address - Phone:616-745-7406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer