Individual provider Active NPI

Laurie Ann Werdehausen, RN

  • Registered Nurse
  • Holts Summit, MO
National Provider Identifier
1972823896
Registry record updated Dec 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
2004005088 Issued in MO
Practice address
11179 County Road 391
Holts Summit, MO 65043-1304
Phone
(573) 694-7978
NPI assigned
Jun 2, 2010
Sex
Female
Sole proprietor
No

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
2004005088MOMDRegistered Nurse

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 2004005088 MO Primary

Addresses

NPPES NPI Registry

Primary practice location

11179 County Road 391
Holts Summit, MO 65043-1304

Mailing address

11179 County Road 391
Holts Summit, MO 65043-1304
Phone (573) 694-7978

Other names 1

NPPES NPI Registry
  • Laurie Ann Goetz Former name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 22, 2011.

{
    "created_epoch": "1275436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324512000000",
    "number": "1972823896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11179 COUNTY ROAD 391",
            "city": "HOLTS SUMMIT",
            "state": "MO",
            "postal_code": "650431304",
            "telephone_number": "573-694-7978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11179 COUNTY ROAD 391",
            "city": "HOLTS SUMMIT",
            "state": "MO",
            "postal_code": "650431304",
            "telephone_number": "573-694-7978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WERDEHAUSEN",
        "first_name": "LAURIE",
        "middle_name": "ANN",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-02",
        "last_updated": "2011-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "2004005088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURIE",
            "last_name": "GOETZ",
            "middle_name": "ANN",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Holts Summit, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.