MEDICARE: LAURETTA KAROLCZAK FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95022174	CA

General Provider Information

NPI Number	:	1093582348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURETTA KAROLCZAK FNP-BC

Provider Business Mailing Address
First Line	:	5050 CYGNET RD
Second Line	:
City	:	PHELAN
State	:	CA
Zip	:	92371-8520
Country	:	US
Telephone Number	:	810-730-2558
Fax Number	:

Provider Business Practice Location Address
First Line	:	15398 MAIN ST
Second Line	:
City	:	HESPERIA
State	:	CA
Zip	:	92345-3390
Country	:	US
Telephone Number	:	760-947-8231
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2023
Last Update Date	:	12/07/2023

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