Provider Demographics
NPI:1558664524
Name:LAUGAVITZ, GAYLENE (RN)
Entity Type:Individual
Prefix:MS
First Name:GAYLENE
Middle Name:
Last Name:LAUGAVITZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:GAYLENE
Other - Middle Name:
Other - Last Name:STEARNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:555 TOWNER ST
Mailing Address - Street 2:PO BOX 915
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5752
Mailing Address - Country:US
Mailing Address - Phone:734-544-3000
Mailing Address - Fax:734-544-6732
Practice Address - Street 1:555 TOWNER ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5752
Practice Address - Country:US
Practice Address - Phone:734-544-3000
Practice Address - Fax:734-544-6732
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704215971163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health