Provider Demographics
NPI:1528510070
Name:WALLS, LAUREN NICHOLE (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:NICHOLE
Last Name:WALLS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:NICHOLE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2000 FOULK RD STE F
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3642
Mailing Address - Country:US
Mailing Address - Phone:302-652-8990
Mailing Address - Fax:302-652-8646
Practice Address - Street 1:2000 FOULK RD STE F
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3642
Practice Address - Country:US
Practice Address - Phone:302-652-8990
Practice Address - Fax:302-652-8646
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
DEC50001317363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical