Provider Demographics
NPI:1366049553
Name:CRIDER, LAUREN NICOLE
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:NICOLE
Last Name:CRIDER
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 1:2901 CASTELLAN LN
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-5689
Mailing Address - Country:US
Mailing Address - Phone:713-501-8840
Mailing Address - Fax:
Practice Address - Street 1:3601 S CONGRESS AVE STE D100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7205
Practice Address - Country:US
Practice Address - Phone:512-614-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1015641363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily