Provider Demographics
NPI:1447802590
Name:IACONI, LAUREN (MOS, PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:IACONI
Suffix:
Gender:F
Credentials:MOS, PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:BRADFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 ROSEMAN CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-6006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:316 LANTANA DR
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8807
Practice Address - Country:US
Practice Address - Phone:302-584-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical