Provider Demographics
NPI:1184968265
Name:PUIA, LAUREN
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:PUIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 HUNTINGTON AVE # SB112
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5018
Mailing Address - Country:US
Mailing Address - Phone:617-585-1284
Mailing Address - Fax:617-585-1208
Practice Address - Street 1:290 HUNTINGTON AVE # SB112
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5018
Practice Address - Country:US
Practice Address - Phone:617-585-1284
Practice Address - Fax:617-585-1208
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009940163WG0000X
IL209-009940363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN250838OtherLICENSE
IL209009940OtherLICENSE