Provider Demographics
NPI:1922470855
Name:FITCH, ELISAN LAUTT (BSN)
Entity Type:Individual
Prefix:
First Name:ELISAN
Middle Name:LAUTT
Last Name:FITCH
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:ELISAN
Other - Middle Name:
Other - Last Name:LAUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:351 HARTNELL AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1845
Mailing Address - Country:US
Mailing Address - Phone:530-247-7910
Mailing Address - Fax:
Practice Address - Street 1:351 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1845
Practice Address - Country:US
Practice Address - Phone:530-247-7910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA569410163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health