Healthcare Provider Details

I. General information

NPI: 1861688897
Provider Name (Legal Business Name): LAURIE B ESCALANTE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 N PINAL AVE
CASA GRANDE AZ
85222-3337
US

IV. Provider business mailing address

1460 N PINAL AVE
CASA GRANDE AZ
85222-3337
US

V. Phone/Fax

Practice location:
  • Phone: 520-876-3627
  • Fax:
Mailing address:
  • Phone: 520-876-3627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN054368
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: