Individual
SHELLY LAUTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6330 W THUNDERBIRD RD, GLENDALE, AZ 85306-4002
(623) 486-6000
Mailing address
6330 W THUNDERBIRD RD, GLENDALE, AZ 85306-4002
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN069134
AZ
Other
Enumeration date
11/20/2014
Last updated
11/20/2014
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