Provider Demographics
NPI:1013229350
Name:SMALL, LAUREN MELISSA (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MELISSA
Last Name:SMALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:315 NW LOST SPRINGS TER
Mailing Address - Street 2:APT #408
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6444
Mailing Address - Country:US
Mailing Address - Phone:513-659-5212
Mailing Address - Fax:
Practice Address - Street 1:19075 NW TANASBOURNE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5860
Practice Address - Country:US
Practice Address - Phone:503-684-8252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2015-02-19
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant