Basic Information
| Provider Information | |||||||||
| NPI: | 1124356985 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PROCACCINI | ||||||||
| FirstName: | LAUREN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 295 DOGWOOD RD | ||||||||
| Address2: | |||||||||
| City: | MILLERSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211081726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106477247 | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 CATON AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212295201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103686000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2009 | ||||||||
| LastUpdateDate: | 12/04/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | R151972 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.