Provider Demographics
NPI:1013398072
Name:SOULES, LAUREN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:SOULES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 HIGHWAY 528 NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-8919
Mailing Address - Country:US
Mailing Address - Phone:505-248-1518
Mailing Address - Fax:
Practice Address - Street 1:3615 HIGHWAY 528 NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-8919
Practice Address - Country:US
Practice Address - Phone:505-248-1518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2015-0034363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant