Healthcare Provider Details

I. General information

NPI: 1689953234
Provider Name (Legal Business Name): LAURA TRAYNOR HERMSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS STREET BWH- GENERAL SURGERY
BOSTON MA
02115-7106
US

IV. Provider business mailing address

75 FRANCIS STREET BWH- GENERAL SURGERY
BOSTON MA
02115-7106
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA4191
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: