Provider Demographics
NPI:1952599615
Name:GREENHAW, LAUREN E (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:E
Last Name:GREENHAW
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 1:3400 SE MACY RD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7841
Mailing Address - Country:US
Mailing Address - Phone:479-845-0880
Mailing Address - Fax:479-845-0887
Practice Address - Street 1:3400 SE MACY RD
Practice Address - Street 2:SUITE 18
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7841
Practice Address - Country:US
Practice Address - Phone:479-845-0880
Practice Address - Fax:479-845-0887
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-324363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical