Provider Demographics
NPI:1215522461
Name:HAYCRAFT, LAURICE EVETTE (MSN, RN, APRN, PMHNP)
Entity type:Individual
Prefix:MRS
First Name:LAURICE
Middle Name:EVETTE
Last Name:HAYCRAFT
Suffix:
Gender:F
Credentials:MSN, RN, APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 BOEING AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336
Mailing Address - Country:US
Mailing Address - Phone:419-870-1888
Mailing Address - Fax:
Practice Address - Street 1:770 MAGNOLIA AVE
Practice Address - Street 2:#2F
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879
Practice Address - Country:US
Practice Address - Phone:951-356-5414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95065093163W00000X
CA95016580363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse