Provider Demographics
NPI:1326146374
Name:NEUBAUER, LAURIE K (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:LAURIE
Middle Name:K
Last Name:NEUBAUER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LAURIE
Other - Middle Name:K
Other - Last Name:NEUBAUER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:1233 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0127
Mailing Address - Country:US
Mailing Address - Phone:406-237-4116
Mailing Address - Fax:
Practice Address - Street 1:1233 N 30TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0127
Practice Address - Country:US
Practice Address - Phone:406-237-4116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT163363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY123539700OtherMDCD PIN
MT000092183OtherBCBS PIN
MT0432480OtherMDCD PIN
MT500012104Medicare PIN
MT970010432Medicare PIN
MT000083945Medicare PIN
MT000092183OtherBCBS PIN
MTS72017Medicare UPIN
MT000081491Medicare PIN
MT000081124Medicare PIN