Provider Demographics
NPI:1548228760
Name:BOHLEY, LAUREN RENEE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:RENEE
Last Name:BOHLEY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:RENEE
Other - Last Name:AMENDOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:33 BEAVER DR
Mailing Address - Street 2:STE 1
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2434
Mailing Address - Country:US
Mailing Address - Phone:814-503-8070
Mailing Address - Fax:814-503-8531
Practice Address - Street 1:33 BEAVER DR
Practice Address - Street 2:STE 1
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2434
Practice Address - Country:US
Practice Address - Phone:814-503-8070
Practice Address - Fax:814-503-8531
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000394L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S71767Medicare UPIN
023403H54Medicare ID - Type Unspecified