Healthcare Provider Details

I. General information

NPI: 1245630250
Provider Name (Legal Business Name): LAUREN M PARKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N ELM ST MOSES CONE EMERGENCY DEPT
GREENSBORO NC
27401-1004
US

IV. Provider business mailing address

2317 CLOVERDALE AVE APT D
WINSTON SALEM NC
27103-2034
US

V. Phone/Fax

Practice location:
  • Phone: 336-207-7005
  • Fax:
Mailing address:
  • Phone: 919-619-3117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-05162
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: