Provider Demographics
NPI:1275831018
Name:LAUZZE, DANIELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:LAUZZE
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 1:64 AVONWOOD RD
Mailing Address - Street 2:APT. A12
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2050
Mailing Address - Country:US
Mailing Address - Phone:814-574-8855
Mailing Address - Fax:
Practice Address - Street 1:21 WATERVILLE RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-2097
Practice Address - Country:US
Practice Address - Phone:814-574-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002543363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant