Provider Demographics
NPI:1184708612
Name:STECK, LARA N (PA)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:N
Last Name:STECK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:NOELLE
Other - Last Name:DINAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:573-884-8526
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-4908
Practice Address - Fax:573-884-3037
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006029627363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO772090OtherHEALTHLINK
MOQ73861Medicare UPIN