Basic Information
| Provider Information | |||||||||
| NPI: | 1144975343 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUNDERGILL | ||||||||
| FirstName: | LAUREN | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5475 GREEN BRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210361251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014010570 | ||||||||
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| Practice Location | |||||||||
| Address1: | 18101 PRINCE PHILIP DR | ||||||||
| Address2: | |||||||||
| City: | OLNEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208321514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017748860 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2022 | ||||||||
| LastUpdateDate: | 03/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R196143 | MD | N | Nursing Service Providers | Registered Nurse | 363LP0808X | R196143 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.