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General NPI Number Information
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NPI Number | 1265069025
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Entity Type | Individual
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Provider Name | LAURA SUZANNE RATY-KERSTETTER FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 11234 ANDERSON ST
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City | LOMA LINDA
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State | CA
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Zip | 92354-2804
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Country | US
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Telephone | 858-354-6889
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Fax |
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Provider Business Mailing Address
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Address Line | 3009 TIFFANY LN
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City | COLTON
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State | CA
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Zip | 92324-9215
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Country | US
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Telephone | 858-354-6889
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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 | 95013202
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 699744
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License Number State | CA
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