Healthcare Provider Details

I. General information

NPI: 1285764456
Provider Name (Legal Business Name): KATHLEEN MARIE LASKAY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CENTER ST
MOBILE AL
36604-3301
US

IV. Provider business mailing address

1191 SMOKERISE DR
MOBILE AL
36695-5061
US

V. Phone/Fax

Practice location:
  • Phone: 251-415-1055
  • Fax:
Mailing address:
  • Phone: 251-633-7531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number1-047277
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: