Provider Demographics
NPI:1356587794
Name:CLARK, LAUREN E (RN)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:E
Last Name:CLARK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:325 COLUMBIA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-1913
Mailing Address - Country:US
Mailing Address - Phone:518-828-4278
Mailing Address - Fax:518-672-0673
Practice Address - Street 1:325 COLUMBIA ST STE 100
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1913
Practice Address - Country:US
Practice Address - Phone:518-828-4278
Practice Address - Fax:518-671-6738
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY485580163WW0101X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03003752Medicaid
NY1114056777Medicaid