Healthcare Provider Details

I. General information

NPI: 1780167122
Provider Name (Legal Business Name): LAUREN MARIE HEALY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS LAUREN MARIE WHITSON

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 W 2ND ST
BLOOMINGTON IN
47403-2209
US

IV. Provider business mailing address

800 WHEELING AVE
GLEN DALE WV
26038-1660
US

V. Phone/Fax

Practice location:
  • Phone: 812-676-4730
  • Fax: 812-676-4731
Mailing address:
  • Phone: 304-845-3211
  • Fax: 812-676-4731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number788
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: