Provider Demographics
NPI:1043657570
Name:GAINES, LAURIE LYNN (LPN/LVN)
Entity Type:Individual
Prefix:MISS
First Name:LAURIE
Middle Name:LYNN
Last Name:GAINES
Suffix:
Gender:F
Credentials:LPN/LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 MCCAGG ST
Mailing Address - Street 2:
Mailing Address - City:PESHTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54157-1435
Mailing Address - Country:US
Mailing Address - Phone:715-923-0957
Mailing Address - Fax:
Practice Address - Street 1:640 MCCAGG ST
Practice Address - Street 2:
Practice Address - City:PESHTIGO
Practice Address - State:WI
Practice Address - Zip Code:54157-1435
Practice Address - Country:US
Practice Address - Phone:715-923-0957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33922-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse