Provider Demographics
NPI:1528269693
Name:JOHN, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:JOHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1265
Mailing Address - Street 2:
Mailing Address - City:KEAMS CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:86034-1265
Mailing Address - Country:US
Mailing Address - Phone:928-738-2318
Mailing Address - Fax:
Practice Address - Street 1:1 MILE WEST OF JEDDITO CHAPTER
Practice Address - Street 2:
Practice Address - City:KEAMS CANYON
Practice Address - State:AZ
Practice Address - Zip Code:86034-1265
Practice Address - Country:US
Practice Address - Phone:928-738-2318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered372500000XNursing Service Related ProvidersChore Provider
Not Answered372600000XNursing Service Related ProvidersAdult Companion
Not Answered3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Not Answered3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Not Answered374U00000XNursing Service Related ProvidersHome Health Aide
Not Answered376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ567860OtherSTATE PROVIDER ID