Provider Demographics
NPI:1992943591
Name:DETERS, LAURA (RN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DETERS
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 1:901 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2191
Mailing Address - Country:US
Mailing Address - Phone:217-347-3003
Mailing Address - Fax:217-347-3005
Practice Address - Street 1:901 MEDICAL PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2191
Practice Address - Country:US
Practice Address - Phone:217-347-3003
Practice Address - Fax:217-347-3005
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041254809163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2500075OtherBCBS
702089OtherHEALTHLINK