Provider Demographics
NPI:1831587781
Name:LEMENAGER, LAUREN (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:LEMENAGER
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 1:122 E WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:FORREST
Mailing Address - State:IL
Mailing Address - Zip Code:61741-9369
Mailing Address - Country:US
Mailing Address - Phone:815-657-8707
Mailing Address - Fax:815-657-8717
Practice Address - Street 1:122 E WABASH AVE
Practice Address - Street 2:
Practice Address - City:FORREST
Practice Address - State:IL
Practice Address - Zip Code:61741-9369
Practice Address - Country:US
Practice Address - Phone:815-657-8707
Practice Address - Fax:815-657-8717
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005214207Q00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine