Provider Demographics
NPI:1972240034
Name:CARR, LAUREN (APRN)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:CARR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 E GRANT HWY # 5
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IL
Mailing Address - Zip Code:60152-3445
Mailing Address - Country:US
Mailing Address - Phone:815-599-3065
Mailing Address - Fax:
Practice Address - Street 1:821 E GRANT HWY # 5
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IL
Practice Address - Zip Code:60152-3445
Practice Address - Country:US
Practice Address - Phone:815-599-3065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.022360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily