Provider Demographics
NPI:1902405442
Name:PINCOMB APODACA, LAUREN ELISE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELISE
Last Name:PINCOMB APODACA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 1/2 BURKE RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-5012
Mailing Address - Country:US
Mailing Address - Phone:575-932-8167
Mailing Address - Fax:
Practice Address - Street 1:2325 1/2 BURKE RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-5012
Practice Address - Country:US
Practice Address - Phone:575-932-8167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-24
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2022-0123363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant