Basic Information
| Provider Information | |||||||||
| NPI: | 1891724571 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOUDERBAUGH | ||||||||
| FirstName: | LAUREL | ||||||||
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| Credential: | RN, MN, ARNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1408 EAST ST | ||||||||
| Address2: | |||||||||
| City: | IOLA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667494402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203653115 | ||||||||
| FaxNumber: | 6203657717 | ||||||||
| Practice Location | |||||||||
| Address1: | 1408 EAST ST | ||||||||
| Address2: | |||||||||
| City: | IOLA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667494402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203653115 | ||||||||
| FaxNumber: | 6203657717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 02/17/2012 | ||||||||
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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 | 363L00000X | 45472 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.