Provider Demographics
NPI:1851989305
Name:LAUREL, LAUREL ESCANO
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:ESCANO
Last Name:LAUREL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-2012
Mailing Address - Country:US
Mailing Address - Phone:575-445-3661
Mailing Address - Fax:575-445-7737
Practice Address - Street 1:203 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-2012
Practice Address - Country:US
Practice Address - Phone:575-445-3661
Practice Address - Fax:575-445-7737
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM62500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily