Provider Demographics
NPI:1184903916
Name:VAN BUREN, LAUREN (PA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:VAN BUREN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:MCCRORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 WASHINGTON ST STE 103
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-8112
Mailing Address - Country:US
Mailing Address - Phone:845-249-2510
Mailing Address - Fax:452-492-5058
Practice Address - Street 1:207 WASHINGTON ST STE 103
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-8112
Practice Address - Country:US
Practice Address - Phone:845-249-2510
Practice Address - Fax:452-492-5058
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002592363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant