Provider Demographics
NPI:1316376619
Name:LASZAKOVITS, COLLEEN (RN, CPD, CLE, CCBE,)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:
Last Name:LASZAKOVITS
Suffix:
Gender:F
Credentials:RN, CPD, CLE, CCBE,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 S CANDLESTICK DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-4528
Mailing Address - Country:US
Mailing Address - Phone:520-440-8446
Mailing Address - Fax:
Practice Address - Street 1:132 S CANDLESTICK DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-4528
Practice Address - Country:US
Practice Address - Phone:520-440-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN102774163WM0102X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn