Individual
LAURA BEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8865 W 400 N STE 155, MICHIGAN CITY, IN 46360-9010
(219) 872-5655
(219) 872-2712
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71005574A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000953975
BCBS BMG VASCULAR
IN
05
—
201307050
—
IN
01
—
P01743678
RR MEDICARE
IN
Enumeration date
06/15/2015
Last updated
02/27/2023
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