Provider Demographics
NPI:1588064646
Name:ADVANCED PRACTICE PRIMARY CARE A REGISTERED NURSING CORPORATION
Entity type:Organization
Organization Name:ADVANCED PRACTICE PRIMARY CARE A REGISTERED NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUGER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:916-838-9794
Mailing Address - Street 1:9267 GREENBACK LN
Mailing Address - Street 2:SUITE C2
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-4863
Mailing Address - Country:US
Mailing Address - Phone:916-539-1449
Mailing Address - Fax:888-990-1397
Practice Address - Street 1:9267 GREENBACK LN
Practice Address - Street 2:SUITE C2
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-4863
Practice Address - Country:US
Practice Address - Phone:916-539-1449
Practice Address - Fax:888-990-1397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444430261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9234OtherNP CERTIFICATE
CARN 444430OtherRN LICENSE
CACA135404Medicare UPIN