Provider Demographics
NPI:1700869054
Name:ABELA, LAUREN V (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:V
Last Name:ABELA
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 1:9975 S EASTERN AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7950
Mailing Address - Country:US
Mailing Address - Phone:702-492-7208
Mailing Address - Fax:702-616-0657
Practice Address - Street 1:9975 S EASTERN AVE STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-7950
Practice Address - Country:US
Practice Address - Phone:702-492-7208
Practice Address - Fax:702-616-0657
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA753363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1700869054Medicaid
NV1700869054Medicaid
NVVCE128YMedicare PIN
NVCE128ZMedicare PIN