Provider Demographics
NPI:1659965697
Name:LAUPER, JOANNA ELLEN (RN)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:ELLEN
Last Name:LAUPER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 LOG POND LN
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-1131
Mailing Address - Country:US
Mailing Address - Phone:209-817-6650
Mailing Address - Fax:
Practice Address - Street 1:191 LOG POND LN
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-1131
Practice Address - Country:US
Practice Address - Phone:209-817-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-20
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV810637163W00000X
CA95231932163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse