Provider Demographics
NPI:1134790199
Name:BRACE, LAUREN EVE (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:EVE
Last Name:BRACE
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 1:11 WHITNEY ST
Mailing Address - Street 2:
Mailing Address - City:MORIAH
Mailing Address - State:NY
Mailing Address - Zip Code:12960-2704
Mailing Address - Country:US
Mailing Address - Phone:518-332-6563
Mailing Address - Fax:
Practice Address - Street 1:380 CREIGHTON ROAD
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953
Practice Address - Country:US
Practice Address - Phone:518-483-0109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant