Healthcare Provider Details

I. General information

NPI: 1255937801
Provider Name (Legal Business Name): LAUREN A PHILLIPS PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 ST LUKES BLVD
EASTON PA
18045-5671
US

IV. Provider business mailing address

1600 ST LUKES BLVD
EASTON PA
18045-5671
US

V. Phone/Fax

Practice location:
  • Phone: 484-503-4500
  • Fax: 484-503-4501
Mailing address:
  • Phone: 484-503-4500
  • Fax: 484-503-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA062114
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA062114
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: