Healthcare Provider Details

I. General information

NPI: 1992897359
Provider Name (Legal Business Name): CAROL ANN LAAGE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 3RD ST
DAYTON OH
45428-9000
US

IV. Provider business mailing address

3478 OLD SALEM RD
DAYTON OH
45415-1233
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-6511
  • Fax: 937-267-7599
Mailing address:
  • Phone: 937-268-6511
  • Fax: 937-267-7599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberNP-6484
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: