Provider Demographics
NPI:1952362303
Name:BEUTLER, LAURA L (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:L
Last Name:BEUTLER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:L
Other - Last Name:BEUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:21802 HERZOG RD
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54230-9169
Mailing Address - Country:US
Mailing Address - Phone:920-754-4634
Mailing Address - Fax:
Practice Address - Street 1:21802 HERZOG RD
Practice Address - Street 2:
Practice Address - City:REEDSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54230-9169
Practice Address - Country:US
Practice Address - Phone:920-754-4634
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI86911-030163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management