Healthcare Provider Details

I. General information

NPI: 1083528616
Provider Name (Legal Business Name): LAUREN OLIVIA LE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 N RONALD REAGAN PKWY STE 254
AVON IN
46123-6911
US

IV. Provider business mailing address

1115 N RONALD REAGAN PKWY STE 254
AVON IN
46123-6911
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-6467
  • Fax: 317-963-7085
Mailing address:
  • Phone: 317-944-6467
  • Fax: 317-963-7085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10005334A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: