Provider Demographics
NPI:1932865318
Name:PATANE-LAITITI, FIAAVAE BETTY (LPN)
Entity Type:Individual
Prefix:
First Name:FIAAVAE
Middle Name:BETTY
Last Name:PATANE-LAITITI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4682 E FOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-6176
Mailing Address - Country:US
Mailing Address - Phone:801-500-7912
Mailing Address - Fax:
Practice Address - Street 1:714 S STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6366
Practice Address - Country:US
Practice Address - Phone:801-426-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10068111-3101164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse