Provider Demographics
NPI:1134369127
Name:BLINN, LAURA JEAN (PA-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:BLINN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 CENTRE AVENUE
Mailing Address - Street 2:CENTER COMMONS BUILDING, SUITE 510
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206
Mailing Address - Country:US
Mailing Address - Phone:412-661-1633
Mailing Address - Fax:412-661-1631
Practice Address - Street 1:5750 CENTRE AVENUE
Practice Address - Street 2:CENTER COMMONS BUILDING, SUITE 510
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206
Practice Address - Country:US
Practice Address - Phone:412-661-1633
Practice Address - Fax:412-661-1631
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052768363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant