Provider Demographics
NPI:1174364566
Name:LEGE, LAUREN GRACE
Entity type:Individual
Prefix:
First Name:LAUREN GRACE
Middle Name:
Last Name:LEGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:ERATH
Mailing Address - State:LA
Mailing Address - Zip Code:70533-3200
Mailing Address - Country:US
Mailing Address - Phone:337-937-5944
Mailing Address - Fax:337-937-8602
Practice Address - Street 1:220 NORTH RD
Practice Address - Street 2:
Practice Address - City:ERATH
Practice Address - State:LA
Practice Address - Zip Code:70533-3200
Practice Address - Country:US
Practice Address - Phone:337-937-5944
Practice Address - Fax:337-937-8602
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-01
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA345585363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant