Provider Demographics
NPI:1649869132
Name:LAROSE, LAURA ALYSSA (PA-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ALYSSA
Last Name:LAROSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ALYSSA
Other - Last Name:URESTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 S HIGHLAND AVE APT 804
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3983
Mailing Address - Country:US
Mailing Address - Phone:956-376-9320
Mailing Address - Fax:
Practice Address - Street 1:121 S HIGHLAND AVE APT 804
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3983
Practice Address - Country:US
Practice Address - Phone:956-376-9320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant