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General NPI Number Information
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NPI Number | 1720370760
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Entity Type | Individual
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Provider Name | LAUREN NICOLE SEDERHOLM PA
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Gender | Female
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Dates
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Enumeration Date | 05/10/2011
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 4407 BEE CAVES RD STE 612
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City | WEST LAKE HILLS
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State | TX
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Zip | 78746-5285
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Country | US
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Telephone | 512-446-9486
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Fax | 512-597-0402
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Provider Business Mailing Address
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Address Line | PO BOX 889230
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City | LOS ANGELES
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State | CA
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Zip | 90088-9230
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Country | US
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Telephone | 512-446-9486
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Fax | 512-597-0402
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA07293
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA07293
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License Number State | TX
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