Provider Demographics
NPI:1982330775
Name:DUTTON, LAUREN MARSHALL
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARSHALL
Last Name:DUTTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MARSHALL
Other - Last Name:BORST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 932958
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0028
Mailing Address - Country:US
Mailing Address - Phone:615-550-2955
Mailing Address - Fax:
Practice Address - Street 1:4726 TRADERS WAY
Practice Address - Street 2:
Practice Address - City:THOMPSONS STATION
Practice Address - State:TN
Practice Address - Zip Code:37179-5366
Practice Address - Country:US
Practice Address - Phone:615-550-2955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5759363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant