Provider Demographics
NPI:1871683177
Name:LAUDERBACH, CLAUDE WARD JR (FNP-C, RN, DNP)
Entity Type:Individual
Prefix:DR
First Name:CLAUDE
Middle Name:WARD
Last Name:LAUDERBACH
Suffix:JR
Gender:M
Credentials:FNP-C, RN, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Mailing Address - Street 1:41553 FAWN TRL
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-4817
Mailing Address - Country:US
Mailing Address - Phone:810-923-7490
Mailing Address - Fax:
Practice Address - Street 1:36200 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1253
Practice Address - Country:US
Practice Address - Phone:734-432-5482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4734328692163W00000X, 163WA2000X
MI4704128692NSA17450363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704128692NSA1450OtherMICHIGAN LICENSING AND REGULATORY AFFAIRS