Provider Demographics
NPI:1649827809
Name:EMA, LAUREN MARIE (APRN)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MARIE
Last Name:EMA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:MASSURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1400 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-3438
Mailing Address - Country:US
Mailing Address - Phone:765-496-0111
Mailing Address - Fax:
Practice Address - Street 1:1400 W STATE ST STE C
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-3438
Practice Address - Country:US
Practice Address - Phone:765-494-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041412336163WG0000X
IN28222970A163WG0000X
IL209.022266363LP0200X
IN71013140A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice