MEDICARE: LOURA D HEUER NP

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	363LP2300X	Primary Care Nurse Practitioner	19509.1464	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19509.1464	OTHER		LICENSE

General Provider Information

NPI Number	:	1972977403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOURA D HEUER NP

Provider Business Mailing Address
First Line	:	3632 AMERICAN WAY
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82604
Country	:	US
Telephone Number	:	307-234-6765
Fax Number	:	307-234-6998

Provider Business Practice Location Address
First Line	:	3632 AMERICAN WAY
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82604
Country	:	US
Telephone Number	:	307-234-6765
Fax Number	:	307-234-6998

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

Provider Enumeration Date	:	11/20/2015
Last Update Date	:	11/27/2017

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