Provider Demographics
NPI:1972907442
Name:WILLIAMS, LAUREN M (PA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:M
Other - Last Name:RHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:41 DONALD B DEAN DR STE A
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3252
Mailing Address - Country:US
Mailing Address - Phone:207-661-6064
Mailing Address - Fax:
Practice Address - Street 1:41 DONALD B DEAN DR STE A
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3252
Practice Address - Country:US
Practice Address - Phone:207-661-6064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018080363A00000X
MAPA6110363A00000X
MEPA2540363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant