Provider Demographics
NPI:1952109803
Name:BAZE, LAUREN RACHELLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:RACHELLE
Last Name:BAZE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:RACHELLE
Other - Last Name:OMDAHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1700 17TH ST NW STE A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2498
Mailing Address - Country:US
Mailing Address - Phone:202-483-4400
Mailing Address - Fax:
Practice Address - Street 1:1700 17TH ST NW STE A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2498
Practice Address - Country:US
Practice Address - Phone:202-483-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110010718363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant