Healthcare Provider Details

I. General information

NPI: 1538190269
Provider Name (Legal Business Name): DEBRA LASETER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 N 44TH ST SUITE #200
PHOENIX AZ
85008-3293
US

IV. Provider business mailing address

2255 N 44TH ST SUITE #200
PHOENIX AZ
85008-3293
US

V. Phone/Fax

Practice location:
  • Phone: 602-424-4204
  • Fax: 602-952-7146
Mailing address:
  • Phone: 602-424-4204
  • Fax: 602-952-7146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP302
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: