Provider Demographics
NPI:1861887689
Name:BRESHEARS, LAUREN WOOD (NP)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:WOOD
Last Name:BRESHEARS
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:1705 E BROADWAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7166
Mailing Address - Country:US
Mailing Address - Phone:573-875-6504
Mailing Address - Fax:573-875-7168
Practice Address - Street 1:1705 E BROADWAY
Practice Address - Street 2:SUITE 220
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7166
Practice Address - Country:US
Practice Address - Phone:573-875-6504
Practice Address - Fax:573-875-7168
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2013032134163W00000X
MO2015007597363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse