Provider Demographics
NPI:1437283777
Name:ECKENRODE, LAUREN LEE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:LEE
Last Name:ECKENRODE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:LEE
Other - Last Name:MARCINKEVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1798
Mailing Address - Country:US
Mailing Address - Phone:866-519-0457
Mailing Address - Fax:570-340-3448
Practice Address - Street 1:700 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1798
Practice Address - Country:US
Practice Address - Phone:866-519-0457
Practice Address - Fax:570-340-3448
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055592363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031544600001Medicaid
PA503751YGDBMedicare PIN