Provider Demographics
NPI:1932874963
Name:STEPHENS, LAUREN ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5533 S 27TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-1664
Mailing Address - Country:US
Mailing Address - Phone:402-423-7000
Mailing Address - Fax:402-423-9399
Practice Address - Street 1:5533 S 27TH ST STE 103
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-1664
Practice Address - Country:US
Practice Address - Phone:402-423-7000
Practice Address - Fax:402-423-9399
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2668207N00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026906600Medicaid