Provider Demographics
NPI:1558847707
Name:CLUBB, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CLUBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ARCH PL STE 2
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2457
Mailing Address - Country:US
Mailing Address - Phone:413-225-2792
Mailing Address - Fax:413-775-9137
Practice Address - Street 1:1 ARCH PL STE 2
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2457
Practice Address - Country:US
Practice Address - Phone:413-225-2792
Practice Address - Fax:413-775-9137
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN277301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN277301OtherAPRN