{{ isset($facility_user_id) && !empty($facility_user_id) ? 'Edit User' : 'Add User' }}
Back to list
User Name:
*
Password
*
Re-Enter Password:
*
Last Name:
*
Middle Name:
First Name:
*
Role:
*
Select One
Enter Specialization:
*
Licensure:
-Select-
MD
DO
PA
APN
RN
LVN
LPN
LMSW
LCSW
CHW
RD
RDN
PT
PTA
BPharm
PharmD
Preferred Language:
English
Spanish
Chinese
Filipino
German
Vietnamese
Select Location:
*
Select Department:
Address:
City:
State:
Country:
Zip Code:
Email Address:
*
Cell Phone: (Enter 10 digit number)
Select Carrier:
Status:
Active
Inactive
NPI(National Provider Identification):
Save
@if($facility_user_id=='')
Reset
@endif
Cancel