Healthcare Provider Details

I. General information

NPI: 1225567282
Provider Name (Legal Business Name): LAUREN ELIZABETH MARSHALL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 06/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 ROBBINS ST
WATERBURY CT
06708-2613
US

IV. Provider business mailing address

157 SQUASSICK RD
WEST SPRINGFIELD MA
01089-1626
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-6000
  • Fax:
Mailing address:
  • Phone: 413-374-4918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: