MEDICARE: LAUREL A LAHITA APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5376030	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477995678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREL A LAHITA APRN

Provider Business Mailing Address
First Line	:	504 N KANSAS AVE
Second Line	:	STE B
City	:	LIBERAL
State	:	KS
Zip	:	67901-3346
Country	:	US
Telephone Number	:	620-275-9434
Fax Number	:	620-275-1448

Provider Business Practice Location Address
First Line	:	504 N KANSAS AVE
Second Line	:	STE B
City	:	LIBERAL
State	:	KS
Zip	:	67901-3346
Country	:	US
Telephone Number	:	620-604-5274
Fax Number	:	844-704-5288

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2013
Last Update Date	:	10/24/2016

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