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Individual
MRS. LIECE LAURENS
Active
Individual
MRS. LIECE LAURENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002825A
IN
363AM0700X
Medical Physician Assistant
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10002825A
INDIANA PROFESSIONAL LICENSING AGENCY
IN
01
—
1168705
NCCPA
—
Enumeration date
10/08/2019
Last updated
01/06/2020
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