Laurie M. Woll D.O.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA17704 Issued in CA

Legal business name

LAURIE M. WOLL D.O.

Practice address

9301 Central Ave Ste 201
Montclair, CA 91763-2446

Phone

(909) 625-5567

Fax

(909) 621-4900

NPI assigned

Apr 22, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shannon A Sehne

Title

Business Manager

Phone

(909) 625-5567

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303430400000",
    "number": "1801187083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9301 CENTRAL AVE., SUITE 201",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "91763",
            "telephone_number": "909-625-5567",
            "fax_number": "909-621-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9301 CENTRAL AVE STE 201",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917632446",
            "telephone_number": "909-625-5567",
            "fax_number": "909-621-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAURIE M. WOLL D.O.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-22",
        "last_updated": "2011-04-22",
        "status": "A",
        "authorized_official_last_name": "SEHNE",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "909-625-5567"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA17704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Janell Nichole Lawrence
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• Tina Nhung Le
• Savannah Leal

• Medical Physician Assistant in Montclair, CA
• Providers in Montclair, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.