Provider Demographics
NPI:1801546494
Name:LAURITZEN, TAMARA KAY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:KAY
Last Name:LAURITZEN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:OELWEIN
Mailing Address - State:IA
Mailing Address - Zip Code:50662-1705
Mailing Address - Country:US
Mailing Address - Phone:563-920-6814
Mailing Address - Fax:
Practice Address - Street 1:721 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-2048
Practice Address - Country:US
Practice Address - Phone:563-927-6700
Practice Address - Fax:563-927-6703
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2021230977363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health