Provider Demographics
NPI:1447758735
Name:LAUER, YEN PHUONG (PA-C)
Entity Type:Individual
Prefix:
First Name:YEN
Middle Name:PHUONG
Last Name:LAUER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:YEN
Other - Middle Name:PHUONG
Other - Last Name:VU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1 NASHUA ST APT 906
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-1607
Mailing Address - Country:US
Mailing Address - Phone:256-617-8487
Mailing Address - Fax:
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-0287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60835121363A00000X
MAPA7162363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty