=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821969924
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREL LEIGH COONEY PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2025
-----------------------------------------------------
Last Update Date | 09/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 PEACH ST STE 200
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16507-1423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-877-7733
-----------------------------------------------------
Fax | 814-877-7745
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 152 E 6TH ST APT 19
-----------------------------------------------------
City | WATERFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16441-6713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | MA067051
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------