Healthcare Provider Details

I. General information

NPI: 1295786911
Provider Name (Legal Business Name): LAUREN T JORDAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN T LABRECQUE PA-C

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 ROCK ROW STE 120
WESTBROOK ME
04092-4877
US

IV. Provider business mailing address

PO BOX 911
BRATTLEBORO VT
05302-0911
US

V. Phone/Fax

Practice location:
  • Phone: 207-303-3300
  • Fax: 207-250-2137
Mailing address:
  • Phone: 207-303-3200
  • Fax: 207-250-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA741
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-741
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2093
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: