Healthcare Provider Details

I. General information

NPI: 1588212039
Provider Name (Legal Business Name): WILLIAM J LAUTENSCHLEGER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 SHAFFER ST
KALAMAZOO MI
49048-1604
US

IV. Provider business mailing address

1910 SHAFFER ST
KALAMAZOO MI
49048-1604
US

V. Phone/Fax

Practice location:
  • Phone: 269-382-9820
  • Fax:
Mailing address:
  • Phone: 269-382-9820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number4704321447
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: