Provider Demographics
NPI:1457460693
Name:LAURIDSEN, DARLENE KAY (CNP)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:KAY
Last Name:LAURIDSEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N SMITH AVE
Mailing Address - Street 2:#100A
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102
Mailing Address - Country:US
Mailing Address - Phone:651-241-7176
Mailing Address - Fax:651-241-5100
Practice Address - Street 1:225 N SMITH AVE
Practice Address - Street 2:#100A
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-241-7176
Practice Address - Fax:651-241-5100
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43937300Medicaid
WI1845OtherAPNP LICENSE
WI491550023Medicare ID - Type Unspecified
WI43937300Medicaid