Provider Demographics
NPI:1558559492
Name:CASAREZ, LAURA (LVN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CASAREZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHPS
Mailing Address - Street 1:2750 SUTTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-1024
Mailing Address - Country:US
Mailing Address - Phone:916-452-3981
Mailing Address - Fax:
Practice Address - Street 1:2150 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-452-3981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN279705164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse