Provider Demographics
NPI:1093806861
Name:DEVRIES, LAURA ASHLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ASHLEY
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 THE FLUME
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-1520
Mailing Address - Country:US
Mailing Address - Phone:281-358-7766
Mailing Address - Fax:281-605-1451
Practice Address - Street 1:28 THE FLUME
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-1520
Practice Address - Country:US
Practice Address - Phone:281-358-7766
Practice Address - Fax:281-605-1451
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01622363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS26016Medicare UPIN
TX83N295Medicare ID - Type UnspecifiedMEDICARE NO.