Provider Demographics
NPI:1992782627
Name:DOME, LAUREN (RN/NP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:DOME
Suffix:
Gender:F
Credentials:RN/NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11206 WELLAND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878
Mailing Address - Country:US
Mailing Address - Phone:301-424-3017
Mailing Address - Fax:240-826-6580
Practice Address - Street 1:9715 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 414
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:240-826-6588
Practice Address - Fax:301-217-9303
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR121173363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1992782627Medicaid