Provider Demographics
NPI:1598720989
Name:FOUTTY, LAURIE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:
Last Name:FOUTTY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:6896 W SNOWVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-3214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 W IRONWOOD DR STE 120E
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-7008
Practice Address - Country:US
Practice Address - Phone:208-625-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID59351363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL225742OtherAMERIGROUP
FL500015919OtherRAILROAD MEDICARE
FL303560300Medicaid
FLP29518Medicare UPIN
FLY9830WMedicare PIN