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NPI Code Detail

MEDICARE: TAMARA KAY LAURITZEN PMHNP-BC

MEDICARE: TAMARA KAY LAURITZEN PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner2021230977IA

General Provider Information

NPI Number : 1801546494
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMARA KAY LAURITZEN PMHNP-BC
Provider Business Mailing Address
First Line : 211 1ST AVE NE
Second Line :
City : OELWEIN
State : IA
Zip : 50662-1705
Country : US
Telephone Number : 563-920-6814
Fax Number :
Provider Business Practice Location Address
First Line : 721 S 5TH ST
Second Line :
City : MANCHESTER
State : IA
Zip : 52057-2048
Country : US
Telephone Number : 563-927-6700
Fax Number : 563-927-6703
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2022
Last Update Date : 01/28/2024

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