Provider Demographics
NPI:1316382419
Name:LASATER, MARIE ELIZABETH (RN, MSN, CCRN, CNRN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ELIZABETH
Last Name:LASATER
Suffix:
Gender:F
Credentials:RN, MSN, CCRN, CNRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14786 HIGHWAY 63
Mailing Address - Street 2:
Mailing Address - City:LICKING
Mailing Address - State:MO
Mailing Address - Zip Code:65542-8274
Mailing Address - Country:US
Mailing Address - Phone:573-364-7551
Mailing Address - Fax:
Practice Address - Street 1:14786 HIGHWAY 63
Practice Address - Street 2:
Practice Address - City:LICKING
Practice Address - State:MO
Practice Address - Zip Code:65542-8274
Practice Address - Country:US
Practice Address - Phone:573-364-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003022718163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse