Provider Demographics
NPI:1750330023
Name:WHITAKER, LAURI MAY (APN, CNM)
Entity Type:Individual
Prefix:
First Name:LAURI
Middle Name:MAY
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:APN, CNM
Other - Prefix:
Other - First Name:LAURI
Other - Middle Name:M
Other - Last Name:BRACKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:780 KUENZLI ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-0845
Mailing Address - Country:US
Mailing Address - Phone:775-982-4590
Mailing Address - Fax:775-982-4595
Practice Address - Street 1:975 RYLAND ST
Practice Address - Street 2:SUITE 105
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1667
Practice Address - Country:US
Practice Address - Phone:775-982-5640
Practice Address - Fax:775-982-5641
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN25658163W00000X
NVAPN000734363LX0001X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
11974233OtherCAQH
NV1750330023Medicaid
01262133OtherAMERIGROUP