Provider Demographics
NPI:1659773422
Name:LAUANO, KAYLENE
Entity Type:Individual
Prefix:
First Name:KAYLENE
Middle Name:
Last Name:LAUANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10322 CHAIN OF ROCK ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8184
Mailing Address - Country:US
Mailing Address - Phone:907-538-9667
Mailing Address - Fax:907-929-9005
Practice Address - Street 1:10322 CHAIN OF ROCK ST
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8184
Practice Address - Country:US
Practice Address - Phone:907-538-9667
Practice Address - Fax:907-538-4002
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1003537172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker