Healthcare Provider Details

I. General information

NPI: 1861305112
Provider Name (Legal Business Name): LAURA ANN DAINAUSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 LOUISE LN
ALLENTOWN PA
18103-5513
US

IV. Provider business mailing address

1055 LOUISE LN
ALLENTOWN PA
18103-5513
US

V. Phone/Fax

Practice location:
  • Phone: 484-719-7030
  • Fax:
Mailing address:
  • Phone: 484-719-7030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA068308
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: