Provider Demographics
NPI:1124306204
Name:REULE, LAURA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:REULE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:MUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:400 HINCKLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-6152
Mailing Address - Country:US
Mailing Address - Phone:517-205-8991
Mailing Address - Fax:
Practice Address - Street 1:400 HINCKLEY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-6152
Practice Address - Country:US
Practice Address - Phone:517-205-8991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-24
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant