Healthcare Provider Details

I. General information

NPI: 1225636228
Provider Name (Legal Business Name): LAURA M GOWER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 09/18/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 DELAWARE AVE
PALMERTON PA
18017
US

IV. Provider business mailing address

128 MABEL LN
EFFORT PA
18330-7792
US

V. Phone/Fax

Practice location:
  • Phone: 484-822-5320
  • Fax:
Mailing address:
  • Phone: 570-236-9296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMA061606
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA061606
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: