Provider Demographics
NPI:1720352040
Name:LAUTERBACH, LAWRENCE WESLEY (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:WESLEY
Last Name:LAUTERBACH
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 MURFREESBORO RD STE 106155
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-1306
Mailing Address - Country:US
Mailing Address - Phone:615-495-5013
Mailing Address - Fax:615-245-6890
Practice Address - Street 1:1604 WESTGATE CIR STE 230
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8074
Practice Address - Country:US
Practice Address - Phone:615-495-5013
Practice Address - Fax:615-245-6890
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000016552363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health