Provider Demographics
NPI:1972823896
Name:WERDEHAUSEN, LAURIE ANN (RN)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:WERDEHAUSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:GOETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11179 COUNTY ROAD 391
Mailing Address - Street 2:
Mailing Address - City:HOLTS SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:65043-1304
Mailing Address - Country:US
Mailing Address - Phone:573-694-7978
Mailing Address - Fax:
Practice Address - Street 1:11179 COUNTY ROAD 391
Practice Address - Street 2:
Practice Address - City:HOLTS SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:65043-1304
Practice Address - Country:US
Practice Address - Phone:573-694-7978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004005088163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse