Provider Demographics
NPI:1366743155
Name:TAYLOR, LAUREN (PA - C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 CLAIRTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15236-3811
Mailing Address - Country:US
Mailing Address - Phone:412-653-5556
Mailing Address - Fax:
Practice Address - Street 1:695 CLAIRTON BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILLS
Practice Address - State:PA
Practice Address - Zip Code:15236-3811
Practice Address - Country:US
Practice Address - Phone:412-653-5556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054568363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant