Provider Demographics
NPI:1265087076
Name:QUEEN, LAUREN WELLS (PA-C)
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:WELLS
Last Name:QUEEN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:11200 GOVERNOR MANLY WAY STE 309
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7375
Mailing Address - Country:US
Mailing Address - Phone:919-819-6171
Mailing Address - Fax:
Practice Address - Street 1:11200 GOVERNOR MANLY WAY STE 309
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7375
Practice Address - Country:US
Practice Address - Phone:919-562-9410
Practice Address - Fax:919-562-2948
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical