Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 10917 | NV |
N | 207Q00000X | Family Doctor | 25MA06943800 | NJ |
N | 207Q00000X | Family Doctor | MD437131 | PA |
N | 207QA0401X | Family Doctor - Addiction Medicine | 25MA06943800 | NJ |
N | 207QA0401X | Family Doctor - Addiction Medicine | MD437131 | PA |
NPI | 1891769808 |
---|---|
Provider Name | Dr. Michele Alisa Di Lauro |
First Address | Las Vegas, NV 89102 |
Second Address | Las Vegas, NV 89103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 05/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100503279 | (05) | NV |
100503659 | (05) | NV |
H38679 | (02) |