Provider Demographics
NPI:1033345913
Name:LAUSTSEN, EMILY CATHERINE (PHYSICIAN ASSISTANT)
Entity Type:Individual
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First Name:EMILY
Middle Name:CATHERINE
Last Name:LAUSTSEN
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Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:560 RIVERSIDE DR
Mailing Address - Street 2:SUITE B204
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-4700
Mailing Address - Country:US
Mailing Address - Phone:410-546-5736
Mailing Address - Fax:410-546-5851
Practice Address - Street 1:560 RIVERSIDE DR
Practice Address - Street 2:SUITE B204
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4700
Practice Address - Country:US
Practice Address - Phone:410-546-5736
Practice Address - Fax:410-546-5851
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2014-01-27
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Provider Licenses
StateLicense IDTaxonomies
MDC0003989363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant