Provider Demographics
NPI:1043642432
Name:BERTUZZI, LAURA S (RN)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:S
Last Name:BERTUZZI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 409
Mailing Address - Street 2:BOX 231
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09053
Mailing Address - Country:US
Mailing Address - Phone:314-440-3816
Mailing Address - Fax:
Practice Address - Street 1:CMR 409
Practice Address - Street 2:BOX 231
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09053
Practice Address - Country:US
Practice Address - Phone:314-440-3816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX521549163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse