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NPI Code Detail

MEDICARE: MRS. LAUREN MARIE DIDIER PA-C

MEDICARE:  MRS. LAUREN MARIE DIDIER  PA-C
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
1363A00000XPhysician Assistant1558762542IN

General Provider Information

NPI Number : 1558762542
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAUREN MARIE DIDIER PA-C
Provider Business Mailing Address
First Line : 608 UNION CHAPEL RD STE A
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-9357
Country : US
Telephone Number : 260-482-4440
Fax Number : 260-482-4442
Provider Business Practice Location Address
First Line : 2200 RANDALLIA DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-4638
Country : US
Telephone Number : 260-373-4000
Fax Number : 260-482-4442
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2014
Last Update Date : 06/18/2026

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Directions to “ MRS. LAUREN MARIE DIDIER PA-C” Practice Location

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