Healthcare Provider Details

I. General information

NPI: 1114591831
Provider Name (Legal Business Name): LAUREN ANN LIEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 GRANDE BLVD SE
RIO RANCHO NM
87124-1756
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-8735
  • Fax: 505-272-8737
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2021-0004
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: