Provider Demographics
NPI:1689231151
Name:MAUL, LAURA AMANDA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:AMANDA
Last Name:MAUL
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 1:413 WASHINGTON ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LILLY
Mailing Address - State:PA
Mailing Address - Zip Code:15938-1162
Mailing Address - Country:US
Mailing Address - Phone:814-656-1536
Mailing Address - Fax:
Practice Address - Street 1:911 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4628
Practice Address - Country:US
Practice Address - Phone:814-940-6065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist