Provider Demographics
NPI:1649448127
Name:TRUMP, LAURALEE B (PA)
Entity type:Individual
Prefix:
First Name:LAURALEE
Middle Name:B
Last Name:TRUMP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LAURALEE
Other - Middle Name:BROOKE
Other - Last Name:ROENIGK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2350 FREEDOM WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-8200
Mailing Address - Country:US
Mailing Address - Phone:717-851-2465
Mailing Address - Fax:717-741-3043
Practice Address - Street 1:2350 FREEDOM WAY STE 200
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8200
Practice Address - Country:US
Practice Address - Phone:717-851-2465
Practice Address - Fax:717-741-3043
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00184200363AM0700X
PAMA053039363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1588525OtherGATEWAY-WMG
PA2503983OtherHIGHMARK BCBS
PA177331FLTMedicare PIN
PA2503983OtherHIGHMARK BCBS