Healthcare Provider Details

I. General information

NPI: 1710402037
Provider Name (Legal Business Name): LAUREN MICHELLE YOUNGER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN M GOBLE PA

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST STE 125B
HARTFORD CT
06106-5501
US

IV. Provider business mailing address

85 SEYMOUR ST STE 125B
HARTFORD CT
06106-5501
US

V. Phone/Fax

Practice location:
  • Phone: 860-962-7022
  • Fax: 860-392-3144
Mailing address:
  • Phone: 860-962-7022
  • Fax: 860-389-3789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7411
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: