Provider Demographics
NPI:1891724571
Name:LOUDERBAUGH, LAUREL (RN, MN, ARNP-C)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:LOUDERBAUGH
Suffix:
Gender:F
Credentials:RN, MN, ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 EAST ST
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-4402
Mailing Address - Country:US
Mailing Address - Phone:620-365-3115
Mailing Address - Fax:620-365-7717
Practice Address - Street 1:1408 EAST ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-4402
Practice Address - Country:US
Practice Address - Phone:620-365-3115
Practice Address - Fax:620-365-7717
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45472363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSQ20873Medicare UPIN
KS161309Medicare ID - Type Unspecified