Provider Demographics
NPI:1184037228
Name:LAULETTA, ELLEN (CRNA, MSN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:LAULETTA
Suffix:
Gender:F
Credentials:CRNA, MSN
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:KANTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA, MSN
Mailing Address - Street 1:139 BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-3379
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:65 W JIMMIE LEEDS RD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08240-9102
Practice Address - Country:US
Practice Address - Phone:609-652-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR16006200367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered