Active NPI
Lauren Elizabeth Collavino
- Acute Care Nurse Practitioner
- Dearborn, MI
National Provider Identifier
1417410739
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acute Care Nurse Practitioner
- License
- 4704302808
- Practice address
- 18101 Oakwood Blvd
Dearborn, MI 48124-4089 - Phone
- (313) 982-5045
- NPI assigned
- Apr 12, 2019
- Last updated
- Sep 18, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 4704302808 | MI | Primary |
| Family Nurse Practitioner | 363LF0000X | 4704302808 | MI |
Addresses
Primary practice location
18101 Oakwood Blvd
Dearborn, MI 48124-4089
Mailing address
60 Haltiner St
River Rouge, MI 48218-1259
Phone (313) 971-9888
Other practice location 1
22201 Moross Rd Ste 352
Detroit, MI 48236-2176
Phone (248) 849-2600
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | lcollavino914921@direct.beaumont.edu | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Interoperability endpoints
- lcollavino1229305@epic00.shdirect.org
- lcollavino250509@direct.hfhs.org
- lcollavino914921@direct.beaumont.edu
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726617600000",
"number": "1417410739",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 HALTINER ST",
"city": "RIVER ROUGE",
"state": "MI",
"postal_code": "482181259",
"telephone_number": "313-971-9888",
"fax_number": "313-971-9888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18101 OAKWOOD BLVD",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481244089",
"telephone_number": "313-982-5045"
}
],
"practiceLocations": [
{
"address_1": "22201 Moross Rd Ste 352",
"address_purpose": "LOCATION",
"city": "Detroit",
"state": "MI",
"postal_code": "482362176",
"country_code": "US",
"telephone_number": "248-849-2600",
"fax_number": "248-849-2610",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "COLLAVINO",
"first_name": "LAUREN",
"middle_name": "ELIZABETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-12",
"last_updated": "2024-09-18",
"certification_date": "2024-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "MI",
"license": "4704302808",
"primary": true
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MI",
"license": "4704302808",
"primary": false
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "lcollavino914921@direct.beaumont.edu",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "18101 Oakwood Blvd",
"city": "Dearborn",
"state": "MI",
"country_code": "US",
"postal_code": "481244089",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.