Provider Demographics
NPI:1538343546
Name:AELLO, LAURA GRACE (RN)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:GRACE
Last Name:AELLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:GRACE
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1360 TOBIAS DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-4452
Mailing Address - Country:US
Mailing Address - Phone:619-623-3887
Mailing Address - Fax:
Practice Address - Street 1:1360 TOBIAS DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-4452
Practice Address - Country:US
Practice Address - Phone:619-623-3887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA630345163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse