Basic Information
Provider Information
NPI: 1861898389
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAUBACH-HUERTA
FirstName: ANGELA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RN, BSN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 206 E BROWN ST
Address2: POCONO HEALTHCARE MANAGEMENT-PROFESSIONAL CENTER
City: EAST STROUDSBURG
State: PA
PostalCode: 183013006
CountryCode: US
TelephoneNumber: 5704204951
FaxNumber: 5704763754
Practice Location
Address1: 2 VETERANS PL
Address2: PMC LEARNING INSTITUTE
City: STROUDSBURG
State: PA
PostalCode: 183602494
CountryCode: US
TelephoneNumber: 5704261688
FaxNumber: 5704261832
Other Information
ProviderEnumerationDate: 11/11/2014
LastUpdateDate: 11/11/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN662605PAY Nursing Service ProvidersRegistered Nurse 

No ID Information.


Home