Provider Demographics
NPI:1811412612
Name:STILES, LAURA MARIE (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:STILES
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PA-C
Mailing Address - Street 1:3 MARCELA DR
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-5769
Mailing Address - Country:US
Mailing Address - Phone:901-833-9404
Mailing Address - Fax:
Practice Address - Street 1:3 MARCELA DR
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-5769
Practice Address - Country:US
Practice Address - Phone:707-459-6115
Practice Address - Fax:707-456-9314
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3345363A00000X
CA60349363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant