Provider Demographics
NPI:1730913120
Name:DEROSE, LAURIE A (RN)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:DEROSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:A
Other - Last Name:BRANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:202 N SYCAMORE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-6150
Mailing Address - Country:US
Mailing Address - Phone:480-472-4852
Mailing Address - Fax:
Practice Address - Street 1:202 N SYCAMORE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6150
Practice Address - Country:US
Practice Address - Phone:480-472-4852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ255634163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool