LIECE LAURENS

FORT WAYNE, IN
NPI1619519915
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363A00000X Physician Assistant
(Licence: IN  10002825A)
Additional Taxonomies363AM0700X Physician Assistant, Medical
Enumeration Date2019-10-08
Last Update Date2020-01-06
Business Address
Mrs. LIECE LAURENS PA-C
7333 W JEFFERSON BLVD
FORT WAYNE, IN 46804-6280
Phone number: 260-458-3830
Mailing Address
Mrs. LIECE LAURENS PA-C
1710 MILLENNIUM XING
FORT WAYNE, IN 46845-8877
Phone number: 510-926-8033