Provider Demographics
NPI:1689220956
Name:MONGE HUERTAS, LAURA DAWN
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DAWN
Last Name:MONGE HUERTAS
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 1:5599 QUAIL MANOR CT # J51
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1819
Mailing Address - Country:US
Mailing Address - Phone:775-354-8583
Mailing Address - Fax:
Practice Address - Street 1:5599 QUAIL MANOR CT # J51
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1819
Practice Address - Country:US
Practice Address - Phone:775-354-8583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide