1396315354 NPI number — MRS. LAUREN MICHELLE ALCORN PMHNP-BC, MSN, RN

Table of content: MRS. LAUREN MICHELLE ALCORN PMHNP-BC, MSN, RN (NPI 1396315354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396315354 NPI number — MRS. LAUREN MICHELLE ALCORN PMHNP-BC, MSN, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALCORN
Provider First Name:
LAUREN
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC, MSN, RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PINEDA
Provider Other First Name:
LAUREN
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396315354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7440 N SHADELAND AVE STE 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46250-2027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-491-1026
Provider Business Mailing Address Fax Number:
888-400-7207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7440 N SHADELAND AVE STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46250-2027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-603-4152
Provider Business Practice Location Address Fax Number:
888-400-7207
Provider Enumeration Date:
06/30/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  71011258A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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