Healthcare Provider Details

I. General information

NPI: 1528319613
Provider Name (Legal Business Name): LAURA M MITROWSKI PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 CAREW ST
SPRINGFIELD MA
01104-2377
US

IV. Provider business mailing address

6 HATFIELD ST
NORTHAMPTON MA
01060-1556
US

V. Phone/Fax

Practice location:
  • Phone: 413-748-9137
  • Fax: 413-452-6049
Mailing address:
  • Phone: 413-748-9137
  • Fax: 413-452-6049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA4506
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: