Individual
LAURIE GIACOLETTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
407 N LINDSAY RD STE 103-104, MESA, AZ 85213-7710
(480) 807-0084
(480) 807-0091
Mailing address
1250 S CLEARVIEW AVE STE 100, MESA, AZ 85209-3378
(480) 988-9108
(480) 813-4460
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5413
AZ
363A00000X
Physician Assistant
9289
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
859739
—
AZ
01
—
Z162194
MEDICARE PTAN
—
Enumeration date
12/15/2005
Last updated
04/16/2015
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