Individual
MISS LAUREN R HANIFY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
200 STATE HIGHWAY 47, MARTHASVILLE, MO 63357-1714
(636) 266-7365
Mailing address
PO BOX 776084, CHICAGO, IL 60677-6084
(314) 364-7586
(314) 645-3801
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2016033277
MO
Other
Enumeration date
11/04/2016
Last updated
04/10/2023
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