Provider Demographics
NPI:1548538796
Name:RECHTSCHAFFEN, LAURALEE FLAHERTY (NP)
Entity type:Individual
Prefix:
First Name:LAURALEE
Middle Name:FLAHERTY
Last Name:RECHTSCHAFFEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 W MARQUITA
Mailing Address - Street 2:UNIT B
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-5184
Mailing Address - Country:US
Mailing Address - Phone:949-521-2367
Mailing Address - Fax:
Practice Address - Street 1:1315 SOUTH COAST HWY
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-0000
Practice Address - Country:US
Practice Address - Phone:949-521-2367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA393267363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner