Provider Demographics
NPI:1972907848
Name:WROGE, LAURA A (PA-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:WROGE
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 1:12860 TROXLER AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-2898
Mailing Address - Country:US
Mailing Address - Phone:618-651-2810
Mailing Address - Fax:
Practice Address - Street 1:12860 TROXLER AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-2898
Practice Address - Country:US
Practice Address - Phone:618-651-2810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059063363A00000X
IL085005359363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400185779Medicare PIN