Provider Demographics
NPI:1366875064
Name:CONNOR, LAURA R (PA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:R
Last Name:CONNOR
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VAN ETTEN
Mailing Address - State:NY
Mailing Address - Zip Code:14889-9716
Mailing Address - Country:US
Mailing Address - Phone:607-589-7546
Mailing Address - Fax:
Practice Address - Street 1:86 MAIN ST
Practice Address - Street 2:
Practice Address - City:VAN ETTEN
Practice Address - State:NY
Practice Address - Zip Code:14889-9716
Practice Address - Country:US
Practice Address - Phone:607-589-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY016965363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant