Individual
LAUREN FAYE IRWIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5114 N GLEN PARK PLACE RD, PEORIA, IL 61614-4686
(309) 683-5600
(309) 683-5607
Mailing address
7 DOCK HILL RD, MIDDLEBURG, PA 17842-8910
(570) 837-2123
(570) 837-2185
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.009665
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103757115
—
PA
01
—
1B1445
MEDICARE
PA
Enumeration date
07/10/2019
Last updated
12/21/2023
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