Provider Demographics
NPI:1619647971
Name:GIESE, LAUREN WALLRICHS (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:WALLRICHS
Last Name:GIESE
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 1:3004 TOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2542
Mailing Address - Country:US
Mailing Address - Phone:919-490-9800
Mailing Address - Fax:919-419-8564
Practice Address - Street 1:3004 TOWER BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2542
Practice Address - Country:US
Practice Address - Phone:919-490-9800
Practice Address - Fax:919-419-8564
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program