Provider Demographics
NPI:1295130342
Name:WILSON, LAUREN HAHN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:HAHN
Last Name:WILSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:HAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7476 WATERSIDE LOOP RD STE 600
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-7680
Mailing Address - Country:US
Mailing Address - Phone:704-601-4381
Mailing Address - Fax:
Practice Address - Street 1:7476 WATERSIDE LOOP RD STE 600
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-7680
Practice Address - Country:US
Practice Address - Phone:704-601-4381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05302363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant