Individual
LAURA E KLUSOVSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
5777E MAYO BLVD, PHOENIX, AZ 85054-4502
(480) 342-2928
Mailing address
5777E MAYO BLVD, PHOENIX, AZ 85054-4502
(480) 342-2928
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
3331
AZ
363A00000X
Physician Assistant
Primary
3331
AZ
363AM0700X
Medical Physician Assistant
3331
AZ
363AS0400X
Surgical Physician Assistant
3331
AZ
Other
Enumeration date
11/23/2005
Last updated
09/03/2020
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