Provider Demographics
NPI:1174652069
Name:NEVINS, LAUREN DARLENE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:DARLENE
Last Name:NEVINS
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 1:6720 LOOP RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2161
Mailing Address - Country:US
Mailing Address - Phone:937-433-4922
Mailing Address - Fax:937-433-6520
Practice Address - Street 1:6720 LOOP RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2161
Practice Address - Country:US
Practice Address - Phone:937-433-4922
Practice Address - Fax:937-433-6520
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002523363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical