| NPI | 1457911786 | 
|---|---|
| Former Name | LAUREN NICOLE SHIVELY | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN10016876)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD F06191176)  | 
| Enumeration Date | 2019-06-18 | 
| Last Update Date | 2025-04-15 |