Provider Demographics
NPI:1295786911
Name:JORDAN, LAUREN T (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:T
Last Name:JORDAN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:T
Other - Last Name:LABRECQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 911
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-0911
Mailing Address - Country:US
Mailing Address - Phone:207-303-3200
Mailing Address - Fax:207-250-2140
Practice Address - Street 1:11 ROCK ROW STE 120
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4877
Practice Address - Country:US
Practice Address - Phone:207-303-3300
Practice Address - Fax:207-250-2137
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2093363A00000X
MEPA-741363AM0700X
MEPA741363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400305232Medicare PIN
MEAP152302Medicare PIN