Provider Demographics
NPI:1366464125
Name:PAOLETTI, LAURA ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:PAOLETTI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 TRANCAS ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2908
Mailing Address - Country:US
Mailing Address - Phone:707-257-7821
Mailing Address - Fax:707-257-2006
Practice Address - Street 1:1100 TRANCAS ST
Practice Address - Street 2:SUITE 250
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2908
Practice Address - Country:US
Practice Address - Phone:707-257-7821
Practice Address - Fax:707-257-2006
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN511005367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0081500Medicaid
CAGR0081501OtherMEDI-CAL
CAZZZ149732Medicare ID - Type Unspecified
CAGR0081500Medicaid