Carolyn J. Laitsch, RN

Individual provider Active NPI Registered Nurse · Shiprock, NM

NPI 1083869705 · NPPES record last updated Nov 21, 2008

Key facts

NPI
1083869705
Entity type
Individual (NPI type 1)
Primary specialty
Registered Nurse 163W00000X
License
107474 (CO)
Practice address
US Hwy 491 North
Shiprock, NM 87420-0160
Phone
(505) 368-6401
Fax
(505) 368-6431
NPI assigned
Nov 21, 2008
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
107474COMDRegistered Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 107474 CO Yes

Addresses

Primary practice location

US Hwy 491 North
Shiprock, NM 87420-0160

Mailing address

PO Box 160
Shiprock, NM 87420-0160
Phone (505) 368-6401

Other providers in Shiprock, NM

All providers in Shiprock, NM · Registered Nurse in New Mexico

Sources for this page

Verify at the official NPI Registry.