Provider Demographics
NPI:1285006775
Name:RICHARD, LAUREN BROGNA (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:BROGNA
Last Name:RICHARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ANDREA
Other - Last Name:BROGNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:192 TILLEY DRIVE
Mailing Address - Street 2:UVM MEDICAL CENTER - ORTHOPEDICS
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403
Mailing Address - Country:US
Mailing Address - Phone:802-847-7063
Mailing Address - Fax:
Practice Address - Street 1:192 TILLEY DRIVE
Practice Address - Street 2:UVM MEDICAL CENTER - ORTHOPEDICS
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403
Practice Address - Country:US
Practice Address - Phone:802-847-7063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055.0031274363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant