Healthcare Provider Details

I. General information

NPI: 1518696269
Provider Name (Legal Business Name): LAUREN DRAKE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 W 21ST ST FL 2
NORFOLK VA
23517-1516
US

IV. Provider business mailing address

PO BOX 639971
CINCINNATI OH
45263-9971
US

V. Phone/Fax

Practice location:
  • Phone: 757-624-1785
  • Fax: 757-624-1759
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110009392
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: