1164511366 NPI number — CATHERINE ANN LAUGESEN CRNP

Table of content: CATHERINE ANN LAUGESEN CRNP (NPI 1164511366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164511366 NPI number — CATHERINE ANN LAUGESEN CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAUGESEN
Provider First Name:
CATHERINE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JUDY
Provider Other First Name:
CATHERINE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164511366
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9800 SAVAGE RD
Provider Second Line Business Mailing Address:
SUITE 6404
Provider Business Mailing Address City Name:
FORT GEORGE G MEADE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20755-5999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-688-7264
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9800 SAVAGE RD
Provider Second Line Business Practice Location Address:
SUITE 6404
Provider Business Practice Location Address City Name:
FORT GEORGE G MEADE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20755-5999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-744-0898
Provider Business Practice Location Address Fax Number:
410-744-2007
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  R140770 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 027108000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 169128Y56 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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