Provider Demographics
NPI:1043889454
Name:HANEY, LAUREN JESSICA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:JESSICA
Last Name:HANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:402 W CHURCH ST APT 208
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-4090
Mailing Address - Country:US
Mailing Address - Phone:210-284-1439
Mailing Address - Fax:
Practice Address - Street 1:1133 JOHN FREEMAN BLVD
Practice Address - Street 2:JJL 285A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2809
Practice Address - Country:US
Practice Address - Phone:713-797-7429
Practice Address - Fax:713-486-0966
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.0790142086S0129X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery