Provider Demographics
NPI:1508600222
Name:KAERCHER, LAUREL BETH
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:BETH
Last Name:KAERCHER
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:PO BOX 714
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:MN
Mailing Address - Zip Code:55731-0714
Mailing Address - Country:US
Mailing Address - Phone:218-235-9112
Mailing Address - Fax:
Practice Address - Street 1:715 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:MN
Practice Address - Zip Code:55731-1337
Practice Address - Country:US
Practice Address - Phone:218-432-0929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker