MEDICARE: MS. LAUREN ELYSE PENN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1235502048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREN ELYSE PENN

Provider Business Mailing Address
First Line	:	1015 N CARROLL AVE
Second Line	:	#2000
City	:	DALLAS
State	:	TX
Zip	:	75204-6613
Country	:	US
Telephone Number	:	214-385-4860
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 N CARROLL AVE
Second Line	:	#2000
City	:	DALLAS
State	:	TX
Zip	:	75204-6613
Country	:	US
Telephone Number	:	214-385-4860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	11/03/2015

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