Individual
LAUREL D. FAUQUHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3600 W BETHEL AVE, MUNCIE, IN 47304-5407
(765) 284-7738
(765) 213-3713
Mailing address
3600 W BETHEL AVE, MUNCIE, IN 47304-5407
(800) 622-6575
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000757A
IN
363AS0400X
Surgical Physician Assistant
10000757A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000351589
ANTHEM PIN
IN
01
—
P00290640
RAILROAD MEDICARE
IN
Enumeration date
08/02/2006
Last updated
01/06/2025
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