Provider Demographics
NPI:1053118927
Name:BAUSLEY, LAURYN DENISE
Entity type:Individual
Prefix:
First Name:LAURYN
Middle Name:DENISE
Last Name:BAUSLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 W WALTON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-5377
Mailing Address - Country:US
Mailing Address - Phone:305-608-9891
Mailing Address - Fax:
Practice Address - Street 1:1433 W WALTON ST APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-5377
Practice Address - Country:US
Practice Address - Phone:305-608-9891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program