Provider Demographics
NPI:1467185017
Name:VANCE, LAUREN MICHELE (PA)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MICHELE
Last Name:VANCE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12268 LONGLEAF OAK TRL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-8434
Mailing Address - Country:US
Mailing Address - Phone:901-634-2380
Mailing Address - Fax:
Practice Address - Street 1:12268 LONGLEAF OAK TRL
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-8434
Practice Address - Country:US
Practice Address - Phone:901-634-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant