Provider Demographics
NPI:1578699005
Name:POLVINO, LAUREN KAY (PA-C, CDE)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:KAY
Last Name:POLVINO
Suffix:
Gender:F
Credentials:PA-C, CDE
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Other - First Name:
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Mailing Address - Street 1:1130 MIDDLE CREEK RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862
Mailing Address - Country:US
Mailing Address - Phone:865-428-7586
Mailing Address - Fax:865-428-8671
Practice Address - Street 1:1130 MIDDLE CREEK RD
Practice Address - Street 2:SUITE 260
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862
Practice Address - Country:US
Practice Address - Phone:865-428-7586
Practice Address - Fax:865-428-8671
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00034700363AM0700X
TNPA0000001981363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical