Provider Demographics
NPI:1447892187
Name:URIE, LAUREN NICOLE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:NICOLE
Last Name:URIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:NICOLE
Other - Last Name:HENSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:542 JENSEN LN
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-0091
Mailing Address - Country:US
Mailing Address - Phone:724-880-5377
Mailing Address - Fax:
Practice Address - Street 1:2215 TOBACCO RD STE F
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-8112
Practice Address - Country:US
Practice Address - Phone:706-396-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024213-01363A00000X
NY024213363A00000X
GA12585363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant