Provider Demographics
NPI:1205239423
Name:MUHLBAUER, LAURIE (PMHNP)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:MUHLBAUER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:TEFFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:1500 NW BETHANY BLVD
Mailing Address - Street 2:STE 320
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006
Mailing Address - Country:US
Mailing Address - Phone:503-567-3260
Mailing Address - Fax:503-567-3264
Practice Address - Street 1:1500 NW BETHANY BLVD
Practice Address - Street 2:STE 320
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006
Practice Address - Country:US
Practice Address - Phone:503-567-3260
Practice Address - Fax:503-567-3264
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201406457RN163WP0808X
OR201406458NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR164936Medicaid
OR164936Medicaid