Provider Demographics
NPI:1811228893
Name:KASS, LAURA ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELIZABETH
Last Name:KASS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:ELIZABETH
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5900 BYRON CENTER AVE SW
Mailing Address - Street 2:MEDICAL ADMINISTRATION
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9606
Mailing Address - Country:US
Mailing Address - Phone:616-252-3243
Mailing Address - Fax:616-252-0260
Practice Address - Street 1:2550 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-8695
Practice Address - Country:US
Practice Address - Phone:616-252-5600
Practice Address - Fax:616-252-5660
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005702363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical