Provider Demographics
NPI:1093935769
Name:STAUBITZ, LAURA ELLEN (RN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELLEN
Last Name:STAUBITZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ELLEN
Other - Last Name:BAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 N COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3307
Mailing Address - Country:US
Mailing Address - Phone:480-472-2907
Mailing Address - Fax:480-472-2899
Practice Address - Street 1:6732 E TYNDALL CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-0867
Practice Address - Country:US
Practice Address - Phone:480-924-7851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN071970163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ580284Medicaid