Provider Demographics
NPI:1134126998
Name:OBERGEFELL, LAURA J (NP-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:OBERGEFELL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 LAGUNA DR
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-2608
Mailing Address - Country:US
Mailing Address - Phone:419-433-6172
Mailing Address - Fax:
Practice Address - Street 1:1111 HAYES AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3323
Practice Address - Country:US
Practice Address - Phone:419-557-6363
Practice Address - Fax:419-557-6361
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP4865363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2352789Medicaid
OH000000324589OtherANTHEM BLUE CROSS
OHP00009985OtherRR RAILROAD
OHNP11471Medicare ID - Type Unspecified
OHP00009985OtherRR RAILROAD