MEDICARE: MS. CHERYL A. LAUX 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	363L00000X	Nurse Practitioner	110333	NE

General Provider Information

NPI Number	:	1558300640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERYL A. LAUX APRN

Provider Business Mailing Address
First Line	:	PO BOX 520
Second Line	:
City	:	BRIDGEPORT
State	:	NE
Zip	:	69336-0520
Country	:	US
Telephone Number	:	308-262-1755
Fax Number	:	308-262-0765

Provider Business Practice Location Address
First Line	:	1320 S ST
Second Line	:
City	:	BRIDGEPORT
State	:	NE
Zip	:	69336-2563
Country	:	US
Telephone Number	:	308-262-1755
Fax Number	:	308-262-0765

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	07/10/2007

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