Healthcare Provider Details

I. General information

NPI: 1952085029
Provider Name (Legal Business Name): LAURA EDWARDS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S MAIN ST
DU BOIS PA
15801-1413
US

IV. Provider business mailing address

2414 MEADOW RD
CLEARFIELD PA
16830-3529
US

V. Phone/Fax

Practice location:
  • Phone: 814-299-7520
  • Fax:
Mailing address:
  • Phone: 814-553-1073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA064652
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA006566
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: