Provider Demographics
NPI:1881300689
Name:ROUP, LAURENE
Entity type:Individual
Prefix:
First Name:LAURENE
Middle Name:
Last Name:ROUP
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 1:321 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-2325
Mailing Address - Country:US
Mailing Address - Phone:814-880-8653
Mailing Address - Fax:
Practice Address - Street 1:321 UNION AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-2325
Practice Address - Country:US
Practice Address - Phone:814-880-8653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay