Provider Demographics
NPI:1295704740
Name:LAINE, ELIZABETH BARBARA (NP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:BARBARA
Last Name:LAINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92223-5599
Mailing Address - Country:US
Mailing Address - Phone:951-845-7157
Mailing Address - Fax:
Practice Address - Street 1:800 E LUGONIA AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2550
Practice Address - Country:US
Practice Address - Phone:909-335-4872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA338761163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory