Provider Demographics
NPI:1598708372
Name:LOUDERMILK, LAURA (FNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:LOUDERMILK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 KENTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-7337
Mailing Address - Country:US
Mailing Address - Phone:530-894-5252
Mailing Address - Fax:
Practice Address - Street 1:85 DECLARATION DR
Practice Address - Street 2:SUITE 110
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-4902
Practice Address - Country:US
Practice Address - Phone:530-894-6600
Practice Address - Fax:530-894-1321
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15489363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15489OtherNURSE PRACTITIONER
CAZZZ04402ZMedicare PIN
BF583BMedicare PIN