Basic Information
| Provider Information | |||||||||
| NPI: | 1285894261 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEAGLE | ||||||||
| FirstName: | LAURINDA | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LITTAU | ||||||||
| OtherFirstName: | LAURI | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6274 SHAW LN SE | ||||||||
| Address2: | |||||||||
| City: | AUMSVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973259561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037492386 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3180 CENTER ST NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973014532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035885351 | ||||||||
| FaxNumber: | 5035854908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2008 | ||||||||
| LastUpdateDate: | 05/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 200742301RN | OR | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.