Provider Demographics
NPI:1619299633
Name:OLTMANNS, LAURA MICHELLE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELLE
Last Name:OLTMANNS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MICHELLE
Other - Last Name:RAINEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29798 HAUN ROAD
Mailing Address - Street 2:STE #106
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92586
Mailing Address - Country:US
Mailing Address - Phone:951-301-3588
Mailing Address - Fax:951-301-4309
Practice Address - Street 1:29798 HAUN ROAD
Practice Address - Street 2:STE #106
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586
Practice Address - Country:US
Practice Address - Phone:951-301-3588
Practice Address - Fax:951-301-4309
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20836363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant