Provider Demographics
NPI:1447690615
Name:KWANKAM, LAUREN STRASSER (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:STRASSER
Last Name:KWANKAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:STRASSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5306 NC HIGHWAY 55 STE 105
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7812
Mailing Address - Country:US
Mailing Address - Phone:919-646-4858
Mailing Address - Fax:919-679-7112
Practice Address - Street 1:5306 NC HIGHWAY 55 STE 105
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7812
Practice Address - Country:US
Practice Address - Phone:919-646-4858
Practice Address - Fax:919-679-7112
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04116363AM0700X
NC0010-04116207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC04116OtherMEDICAL