Provider Demographics
NPI:1235403460
Name:STILLMAN, LAURA JANE (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JANE
Last Name:STILLMAN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14651 S BASCOM AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2014
Mailing Address - Country:US
Mailing Address - Phone:408-356-9300
Mailing Address - Fax:
Practice Address - Street 1:14651 S BASCOM AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2014
Practice Address - Country:US
Practice Address - Phone:408-356-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21922363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical