Provider Demographics
NPI:1871164202
Name:DANDURAND, LAUREN ASHLEY
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ASHLEY
Last Name:DANDURAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 RAINTREE DR APT U9
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2471
Mailing Address - Country:US
Mailing Address - Phone:586-612-1376
Mailing Address - Fax:
Practice Address - Street 1:2719 RAINTREE DR APT U9
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2471
Practice Address - Country:US
Practice Address - Phone:586-612-1376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0023855225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist