Healthcare Provider Details

I. General information

NPI: 1508693524
Provider Name (Legal Business Name): LAUREN E CUNNINGHAM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2024
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 RILEY HOSPITAL DR
INDIANAPOLIS IN
46202-5272
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-7728
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10004530A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: