Provider Demographics
NPI:1306383419
Name:SISSER, LAURIE ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ANN
Last Name:SISSER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:REISENAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:123 3RD STREET, SUITE #1
Mailing Address - Street 2:FOREVER LIFE HOME HEALTH CARE
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318
Mailing Address - Country:US
Mailing Address - Phone:952-361-3052
Mailing Address - Fax:952-361-3053
Practice Address - Street 1:123 W. 3RD STREET, SUITE #1
Practice Address - Street 2:FOREVER LIFE HOME HEALTH CARE
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318
Practice Address - Country:US
Practice Address - Phone:952-361-3052
Practice Address - Fax:952-361-3053
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR085787-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse