Provider Demographics
NPI:1578550786
Name:BEITER, LAURA K (CRNA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:K
Last Name:BEITER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3101 BRECKENRIDGE LN
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2742
Mailing Address - Country:US
Mailing Address - Phone:502-458-7400
Mailing Address - Fax:502-458-7449
Practice Address - Street 1:3920 DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4702
Practice Address - Country:US
Practice Address - Phone:502-259-6710
Practice Address - Fax:502-259-6704
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN28171598A163W00000X
KY1103388367500000X
KY3004298367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2818456000OtherPASSPORT ADVANTAGE
KY7100110460Medicaid
KY000000325671OtherANTHEM BLUE SHIELD
IN201352290Medicaid
KY50013921OtherPASSPORT
P00184515OtherRAILROAD MEDICARE