Provider Demographics
NPI:1528500766
Name:HANIFY, LAUREN R (PA-C)
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:R
Last Name:HANIFY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:R
Other - Last Name:NEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:314-364-7586
Mailing Address - Fax:314-645-3801
Practice Address - Street 1:200 STATE HIGHWAY 47
Practice Address - Street 2:
Practice Address - City:MARTHASVILLE
Practice Address - State:MO
Practice Address - Zip Code:63357-1714
Practice Address - Country:US
Practice Address - Phone:636-266-7365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016033277363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical