Provider Demographics
NPI:1063158228
Name:SUITS, LAUREN T (NP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:T
Last Name:SUITS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 FLAT SWAMP LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27239-6939
Mailing Address - Country:US
Mailing Address - Phone:336-803-0695
Mailing Address - Fax:
Practice Address - Street 1:ADVANCED LASER & SKIN REJUVENATION
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265
Practice Address - Country:US
Practice Address - Phone:336-841-4025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC301746163WP2201X
NC5016943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
301746OtherNCBON
5016943OtherNCBON NP LICENSE