1477073708 NPI number — MRS. HEATHER SAMANTHA LAFFIN RN

Table of content: MRS. HEATHER SAMANTHA LAFFIN RN (NPI 1477073708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477073708 NPI number — MRS. HEATHER SAMANTHA LAFFIN RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAFFIN
Provider First Name:
HEATHER
Provider Middle Name:
SAMANTHA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUERTA
Provider Other First Name:
HEATHER
Provider Other Middle Name:
SAMANTHA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477073708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
675 RIDGE RD TRLR 214
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOSINEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54455-8734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-432-3790
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
675 RIDGE ROAD
Provider Second Line Business Practice Location Address:
TRAILER 214
Provider Business Practice Location Address City Name:
MOSINEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-432-3790
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  201510 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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