Provider Demographics
NPI:1649463951
Name:TRUSHEL, LARA PORTER (PA-C)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:PORTER
Last Name:TRUSHEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:GILLELAND
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3113 GREEN GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-1000
Mailing Address - Country:US
Mailing Address - Phone:724-770-7171
Mailing Address - Fax:
Practice Address - Street 1:3113 GREEN GARDEN RD
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001
Practice Address - Country:US
Practice Address - Phone:724-770-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052950363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical