Provider Demographics
NPI:1740412915
Name:JAEGER, LAURA HOLDEN (PAC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:HOLDEN
Last Name:JAEGER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 FARMINGTON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2383
Mailing Address - Country:US
Mailing Address - Phone:860-284-4950
Mailing Address - Fax:
Practice Address - Street 1:599 FARMINGTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2383
Practice Address - Country:US
Practice Address - Phone:860-284-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013469363A00000X
CT003488363AM0700X
CT3488363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical