Healthcare Provider Details

I. General information

NPI: 1215755103
Provider Name (Legal Business Name): LAUREN ASHLEY HEUTSCHE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 01/18/2025
Certification Date: 01/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 FRANKLIN ST STE 110
FRAMINGHAM MA
01702-6265
US

IV. Provider business mailing address

475 FRANKLIN ST STE 110
FRAMINGHAM MA
01702-6265
US

V. Phone/Fax

Practice location:
  • Phone: 508-620-9200
  • Fax:
Mailing address:
  • Phone: 508-620-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1224828
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: