Provider Demographics
NPI:1770726960
Name:ERNST, LAURA THERESA (RN, CNOR, RNFA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:THERESA
Last Name:ERNST
Suffix:
Gender:F
Credentials:RN, CNOR, RNFA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:THERESA
Other - Last Name:ERNST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2745 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-7201
Mailing Address - Country:US
Mailing Address - Phone:563-242-3208
Mailing Address - Fax:563-242-4051
Practice Address - Street 1:2745 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-7201
Practice Address - Country:US
Practice Address - Phone:563-242-3208
Practice Address - Fax:563-242-4051
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA104607163W00000X
IL041.351951163W00000X
CONA163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant