Provider Demographics
NPI:1396140570
Name:KALU, LAURA (BSN, RN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KALU
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12401 ACADEMY RD
Mailing Address - Street 2:210
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1932
Mailing Address - Country:US
Mailing Address - Phone:888-851-5967
Mailing Address - Fax:267-538-6529
Practice Address - Street 1:12401 ACADEMY RD
Practice Address - Street 2:210
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1932
Practice Address - Country:US
Practice Address - Phone:888-851-5967
Practice Address - Fax:267-538-6529
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2015-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA262036013747P1801X, 3747A0650X, 374U00000X, 376J00000X, 376K00000X, 376K00000X, 3747A0650X
PARN659686163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide
Yes163W00000XNursing Service ProvidersRegistered Nurse