Basic Information
Provider Information | |||||||||
NPI: | 1366464125 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PAOLETTI | ||||||||
FirstName: | LAURA | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | NP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1100 TRANCAS ST | ||||||||
Address2: | SUITE 250 | ||||||||
City: | NAPA | ||||||||
State: | CA | ||||||||
PostalCode: | 945582908 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7072577821 | ||||||||
FaxNumber: | 7072572006 | ||||||||
Practice Location | |||||||||
Address1: | 1100 TRANCAS ST | ||||||||
Address2: | SUITE 250 | ||||||||
City: | NAPA | ||||||||
State: | CA | ||||||||
PostalCode: | 945582908 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7072577821 | ||||||||
FaxNumber: | 7072572006 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/24/2006 | ||||||||
LastUpdateDate: | 05/06/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | RN511005 | CA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |   |
ID Information
ID | Type | State | Issuer | Description | GR0081500 | 05 | CA |   | MEDICAID | GR0081501 | 01 | CA | MEDI-CAL | OTHER |