Provider Demographics
NPI:1245241116
Name:HUGHELL, LAURIE (PA)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:HUGHELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-9699
Mailing Address - Fax:515-643-9698
Practice Address - Street 1:8421 PLUM DR
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-7356
Practice Address - Country:US
Practice Address - Phone:515-270-7222
Practice Address - Fax:515-270-7202
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01603363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA11878OtherWELLMARK BLUE SHIELD
IAI18243Medicare PIN