Provider Demographics
NPI:1144427923
Name:LOK, LAURA K (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:K
Last Name:LOK
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 1:200 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2479
Mailing Address - Country:US
Mailing Address - Phone:860-676-9000
Mailing Address - Fax:860-676-1546
Practice Address - Street 1:200 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2479
Practice Address - Country:US
Practice Address - Phone:860-676-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001857363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC001857OtherSTATE LICENSE NUMBER