Provider Demographics
NPI:1053110528
Name:LAUER, JESTIN NEAL (PA-S)
Entity type:Individual
Prefix:
First Name:JESTIN
Middle Name:NEAL
Last Name:LAUER
Suffix:
Gender:
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12398 N COUNTY ROAD 100 E
Mailing Address - Street 2:
Mailing Address - City:CHRISNEY
Mailing Address - State:IN
Mailing Address - Zip Code:47611-9514
Mailing Address - Country:US
Mailing Address - Phone:812-489-0909
Mailing Address - Fax:
Practice Address - Street 1:12398 N COUNTY ROAD 100 E
Practice Address - Street 2:
Practice Address - City:CHRISNEY
Practice Address - State:IN
Practice Address - Zip Code:47611-9514
Practice Address - Country:US
Practice Address - Phone:812-489-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant