Provider Demographics
NPI:1407826126
Name:METHVIN, LAURIE J (ARNP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:J
Last Name:METHVIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-3745
Mailing Address - Country:US
Mailing Address - Phone:316-283-6103
Mailing Address - Fax:316-283-0453
Practice Address - Street 1:209 S PINE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-3745
Practice Address - Country:US
Practice Address - Phone:316-283-6103
Practice Address - Fax:316-283-0453
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS44908363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000161953OtherBLUE CROSS BLUE SHIELD
S86540Medicare UPIN
160811Medicare ID - Type Unspecified