Individual
LAURA LYNN KOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110-003378
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110003378
LICENSE
VA
05
—
1699850032
—
VA
01
—
P00869721
RR MEDICARE PIN
—
Enumeration date
10/20/2009
Last updated
12/04/2022
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