Provider Demographics
NPI:1093582348
Name:KAROLCZAK, LAURETTA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LAURETTA
Middle Name:
Last Name:KAROLCZAK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 CYGNET RD
Mailing Address - Street 2:
Mailing Address - City:PHELAN
Mailing Address - State:CA
Mailing Address - Zip Code:92371-8520
Mailing Address - Country:US
Mailing Address - Phone:810-730-2558
Mailing Address - Fax:
Practice Address - Street 1:15398 MAIN ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3390
Practice Address - Country:US
Practice Address - Phone:760-947-8231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022174363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily