# MRS. LIECE LAURENS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1619519915
- **Gender:** F
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 10002825A | IN | Yes |
| 363AM0700X | Medical Physician Assistant | — | NULL | — |

## Other

- **Enumeration date:** 10/08/2019
- **Last updated:** 01/06/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 10002825A | INDIANA PROFESSIONAL LICENSING AGENCY | IN |
| 01 | — | 1168705 | NCCPA | — |