Provider Demographics
NPI:1023622750
Name:LAUTERBACH, MEGAN PAIGE (RN)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:PAIGE
Last Name:LAUTERBACH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 CAPTAINS BAY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-7863
Mailing Address - Country:US
Mailing Address - Phone:361-463-1555
Mailing Address - Fax:
Practice Address - Street 1:4444 CORONA DR STE 106
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4323
Practice Address - Country:US
Practice Address - Phone:361-520-4038
Practice Address - Fax:361-520-4049
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001662163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health