Provider Demographics
NPI:1518368885
Name:WEINBERG, LAUREN (MHS, PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:WEINBERG
Suffix:
Gender:F
Credentials:MHS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57950 LEAVENWORTH ST
Mailing Address - Street 2:MCCONNELL AFB
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:67221
Mailing Address - Country:US
Mailing Address - Phone:316-759-6300
Mailing Address - Fax:
Practice Address - Street 1:8200 E BELLEVIEW AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2803
Practice Address - Country:US
Practice Address - Phone:303-649-3710
Practice Address - Fax:303-649-3711
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1121024363A00000X
COPA.0005015363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant