Healthcare Provider Details

I. General information

NPI: 1396768628
Provider Name (Legal Business Name): DALE F LAUR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 N MAIN ST
LAPEER MI
48446-1350
US

IV. Provider business mailing address

2108 JOHNSON MILL RD
NORTH BRANCH MI
48461-9581
US

V. Phone/Fax

Practice location:
  • Phone: 810-667-5655
  • Fax:
Mailing address:
  • Phone: 810-688-4958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704175887
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: