Provider Demographics
NPI:1245603778
Name:MARSHBURN, LAURA (LVN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:MARSHBURN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:AINZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:163 LOTUS DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-5928
Mailing Address - Country:US
Mailing Address - Phone:619-227-3562
Mailing Address - Fax:
Practice Address - Street 1:2851 MEADOW LARK DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2709
Practice Address - Country:US
Practice Address - Phone:858-571-1964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA159108164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse