Basic Information
| Provider Information | |||||||||
| NPI: | 1811247992 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CREPEAU | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | HEATON | ||||||||
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| Credential: | NNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 286 MIDVALE DR NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303423327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4049156347 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5901-B PEACHTREE DUNWOODY ROAD | ||||||||
| Address2: | SUITE B-420 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303287156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042529751 | ||||||||
| FaxNumber: | 4042555783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2012 | ||||||||
| LastUpdateDate: | 04/25/2014 | ||||||||
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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 | 163W00000X | RN184100 | GA | N | Nursing Service Providers | Registered Nurse | 363LN0000X | RN184100 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal |
No ID Information.