Provider Demographics
NPI:1730573593
Name:SCHLOTTERER, LAURA DORAME (LPN)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:DORAME
Last Name:SCHLOTTERER
Suffix:
Gender:F
Credentials:LPN
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 810
Mailing Address - Street 2:
Mailing Address - City:SELLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85634-0810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AZ STATE HIGHWAY 86
Practice Address - Street 2:MILE POST 112
Practice Address - City:SELLS
Practice Address - State:AZ
Practice Address - Zip Code:85634-0810
Practice Address - Country:US
Practice Address - Phone:520-383-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP041314164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse