Provider Demographics
NPI:1164021481
Name:LAFRAUGH, AUDREY LAINE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:LAINE
Last Name:LAFRAUGH
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 1:721 LOOMIS CIR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6924
Mailing Address - Country:US
Mailing Address - Phone:425-256-0038
Mailing Address - Fax:
Practice Address - Street 1:5385 FRANKLIN BLVD STE A-D
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-4717
Practice Address - Country:US
Practice Address - Phone:916-452-7305
Practice Address - Fax:916-452-9753
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58740363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant