Provider Demographics
NPI:1477028215
Name:O'CONNOR, LAUREN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:O'CONNOR
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 1:1106 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9145
Mailing Address - Country:US
Mailing Address - Phone:336-906-7868
Mailing Address - Fax:
Practice Address - Street 1:604 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-9515
Practice Address - Country:US
Practice Address - Phone:336-454-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08429363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty