Provider Demographics
NPI:1326377375
Name:SNEGOSKY, LAURIE ANN (RN/PHN)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:SNEGOSKY
Suffix:
Gender:F
Credentials:RN/PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 FORD AVE N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GLENCOE
Mailing Address - State:MN
Mailing Address - Zip Code:55336-1363
Mailing Address - Country:US
Mailing Address - Phone:320-864-3185
Mailing Address - Fax:320-864-1484
Practice Address - Street 1:1805 FORD AVE N
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENCOE
Practice Address - State:MN
Practice Address - Zip Code:55336-1363
Practice Address - Country:US
Practice Address - Phone:320-864-3185
Practice Address - Fax:320-864-1484
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR128648-3163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR1286483OtherRN LICENCE NUMBER