Healthcare Provider Details

I. General information

NPI: 1376383729
Provider Name (Legal Business Name): LAUREN ALEXIS CARDENAS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN ALEXIS PITTS

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WASON AVE STE 100
SPRINGFIELD MA
01107-1179
US

IV. Provider business mailing address

100 WASON AVE STE 100
SPRINGFIELD MA
01107-1179
US

V. Phone/Fax

Practice location:
  • Phone: 413-233-2045
  • Fax:
Mailing address:
  • Phone: 413-233-2045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA101439
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: