MEDICARE: LAURA LOUDERMILK FNP

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	15489	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15489	OTHER	CA	NURSE PRACTITIONER

General Provider Information

NPI Number	:	1598708372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA LOUDERMILK FNP

Provider Business Mailing Address
First Line	:	1115 KENTFIELD RD
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-7337
Country	:	US
Telephone Number	:	530-894-5252
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 DECLARATION DR
Second Line	:	SUITE 110
City	:	CHICO
State	:	CA
Zip	:	95973-4902
Country	:	US
Telephone Number	:	530-894-6600
Fax Number	:	530-894-1321

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	12/14/2012

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