Basic Information
| Provider Information | |||||||||
| NPI: | 1124460217 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELL | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1292 HIGH ST STE 224 | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974013238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415002500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 87983 TERRITORIAL RD | ||||||||
| Address2: | |||||||||
| City: | VENETA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974878775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416407625 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2013 | ||||||||
| LastUpdateDate: | 01/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 016734 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | PA185443 | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 03690342 | 05 | NY | MEDICAID |