Provider Demographics
NPI:1912032905
Name:BOLAND, LAURA M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:M
Last Name:BOLAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:126 E CHURCH ST STE 2200
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2271
Mailing Address - Country:US
Mailing Address - Phone:814-443-5249
Mailing Address - Fax:814-443-5008
Practice Address - Street 1:126 E CHURCH ST STE 2200
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2271
Practice Address - Country:US
Practice Address - Phone:814-443-5249
Practice Address - Fax:814-443-5008
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA003374L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical