Provider Demographics
NPI:1932155363
Name:MINER, LAURA ANN (PA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:MINER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 EVANS ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-3110
Mailing Address - Country:US
Mailing Address - Phone:585-343-1250
Mailing Address - Fax:585-343-8394
Practice Address - Street 1:7 EVANS ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3110
Practice Address - Country:US
Practice Address - Phone:585-343-1250
Practice Address - Fax:585-343-8394
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005533363AM0700X
NY005533-1207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02354245Medicaid
NY000570439002OtherBC/BS OF WNY
NY02354245Medicaid