Provider Demographics
NPI:1841932316
Name:LAATSCH, DARLA RUTH MUDGE (FNP)
Entity type:Individual
Prefix:
First Name:DARLA
Middle Name:RUTH MUDGE
Last Name:LAATSCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3073 COLINA VERDE LN
Mailing Address - Street 2:
Mailing Address - City:JAMUL
Mailing Address - State:CA
Mailing Address - Zip Code:91935-3005
Mailing Address - Country:US
Mailing Address - Phone:619-303-2671
Mailing Address - Fax:
Practice Address - Street 1:3073 COLINA VERDE LN
Practice Address - Street 2:
Practice Address - City:JAMUL
Practice Address - State:CA
Practice Address - Zip Code:91935-3005
Practice Address - Country:US
Practice Address - Phone:619-507-0848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA407472163W00000X
CA95021056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse