Provider Demographics
NPI:1528168655
Name:LAIDMAN, BARBARA (NP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:LAIDMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 W 24TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6227
Mailing Address - Country:US
Mailing Address - Phone:928-726-2500
Mailing Address - Fax:928-726-7853
Practice Address - Street 1:1210 W 24TH ST STE 2
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6227
Practice Address - Country:US
Practice Address - Phone:928-726-2500
Practice Address - Fax:928-726-7853
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN123701164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ812538Medicaid
AZZ76957Medicare ID - Type Unspecified
AZ812538Medicaid