Healthcare Provider Details

I. General information

NPI: 1558771352
Provider Name (Legal Business Name): ASHLEY LAUTAR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 E GREENWAY RD
PHOENIX AZ
85032-4548
US

IV. Provider business mailing address

3202 E GREENWAY RD
PHOENIX AZ
85032-4548
US

V. Phone/Fax

Practice location:
  • Phone: 602-325-5577
  • Fax:
Mailing address:
  • Phone: 602-325-5577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6951
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP.15677
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA 15677-NP
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number283134
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: