Provider Demographics
NPI:1720058332
Name:LAUBE, LAVON PAULA (PA)
Entity type:Individual
Prefix:
First Name:LAVON
Middle Name:PAULA
Last Name:LAUBE
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:PO BOX 4557
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-4557
Mailing Address - Country:US
Mailing Address - Phone:866-290-4325
Mailing Address - Fax:515-280-9525
Practice Address - Street 1:850 ORCHARD STREET
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-5412
Practice Address - Country:US
Practice Address - Phone:866-290-4325
Practice Address - Fax:515-280-9525
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000713363A00000X
IA000713PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P29488Medicare UPIN
I1688Medicare ID - Type Unspecified