Provider Demographics
NPI:1033688726
Name:AX, LAUREN MCKENZIE (MSPAS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MCKENZIE
Last Name:AX
Suffix:
Gender:F
Credentials:MSPAS, PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:APPLEGATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 61025
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082-1025
Mailing Address - Country:US
Mailing Address - Phone:480-681-3300
Mailing Address - Fax:480-681-3301
Practice Address - Street 1:4425 E AGAVE RD STE 148
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-0623
Practice Address - Country:US
Practice Address - Phone:480-704-7546
Practice Address - Fax:480-704-7549
Is Sole Proprietor?:No
Enumeration Date:2018-11-25
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060393363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant