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General NPI Number Information
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NPI Number | 1174019228
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Entity Type | Individual
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Provider Name | LAURA MERCADO HALTERMAN DNP FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/02/2018
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 16245 DESERT KNOLL DR
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City | VICTORVILLE
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State | CA
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Zip | 92395-4011
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Country | US
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Telephone | 760-955-9555
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Fax | 760-955-8558
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Provider Business Mailing Address
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Address Line | 17573 CENTURY PLANT RD
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City | APPLE VALLEY
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State | CA
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Zip | 92307-6995
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Country | US
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Telephone | 760-490-2445
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95009211
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License Number State | CA
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