Provider Demographics
NPI:1093955858
Name:BOATMAN, LAURA ANN
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:BOATMAN
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 1:506 CORTE AGUACATE
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1861
Mailing Address - Country:US
Mailing Address - Phone:805-642-7033
Mailing Address - Fax:805-642-7201
Practice Address - Street 1:5810 RALSTON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6010
Practice Address - Country:US
Practice Address - Phone:805-642-7033
Practice Address - Fax:805-642-7201
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN143946164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA164X00C00XOtherLICENSED VOCATIONAL NURSE