Provider Demographics
NPI:1477951705
Name:BLEVINS, LAUREN O
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:O
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:M
Other - Last Name:O'NEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-7000
Mailing Address - Fax:717-767-8985
Practice Address - Street 1:1401 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-2244
Practice Address - Country:US
Practice Address - Phone:717-812-7000
Practice Address - Fax:717-767-8985
Is Sole Proprietor?:No
Enumeration Date:2014-12-19
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP01437510Medicare PIN
PA389411FLTMedicare PIN