Provider Demographics
NPI:1225572043
Name:LETTS, LAURA MCKENZIE (CNM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MCKENZIE
Last Name:LETTS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 CATALINA DR # 200
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1605
Mailing Address - Country:US
Mailing Address - Phone:541-201-4850
Mailing Address - Fax:
Practice Address - Street 1:560 CATALINA DR STE 200
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1605
Practice Address - Country:US
Practice Address - Phone:541-201-4390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20551363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology