Provider Demographics
NPI:1033574710
Name:AJERO, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:AJERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-2295
Mailing Address - Country:US
Mailing Address - Phone:602-241-6656
Mailing Address - Fax:602-241-7506
Practice Address - Street 1:1035 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-2295
Practice Address - Country:US
Practice Address - Phone:602-241-6656
Practice Address - Fax:602-241-7506
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPO24142164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ034682Medicare PIN