Provider Demographics
NPI:1619337078
Name:ARNDTS, LARA M
Entity Type:Individual
Prefix:MRS
First Name:LARA
Middle Name:M
Last Name:ARNDTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 PETERS AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-3973
Mailing Address - Country:US
Mailing Address - Phone:937-670-4926
Mailing Address - Fax:
Practice Address - Street 1:325 PETERS AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-3973
Practice Address - Country:US
Practice Address - Phone:937-670-4926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-28
Last Update Date:2016-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH312325163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH163W00000XOtherNURSING SERVICE PROVIDERS