Provider Demographics
NPI:1093203846
Name:DERANLEAU, LAURIE L (RND)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:L
Last Name:DERANLEAU
Suffix:
Gender:F
Credentials:RND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 S VIEW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98595-9747
Mailing Address - Country:US
Mailing Address - Phone:360-580-1897
Mailing Address - Fax:
Practice Address - Street 1:2165 S VIEW RIDGE DR
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:WA
Practice Address - Zip Code:98595-9747
Practice Address - Country:US
Practice Address - Phone:360-580-1897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00142815163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse