Provider Demographics
NPI:1235502048
Name:PENN, LAUREN ELYSE
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:ELYSE
Last Name:PENN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 N CARROLL AVE
Mailing Address - Street 2:#2000
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6613
Mailing Address - Country:US
Mailing Address - Phone:214-385-4860
Mailing Address - Fax:
Practice Address - Street 1:1015 N CARROLL AVE
Practice Address - Street 2:#2000
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6613
Practice Address - Country:US
Practice Address - Phone:214-385-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant