Provider Demographics
NPI:1467580977
Name:LAURENCE NORDIN
Entity Type:Organization
Organization Name:LAURENCE NORDIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRST ASSISTANTE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:NORDIN
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:209-526-4500
Mailing Address - Street 1:2116 EASTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1439
Mailing Address - Country:US
Mailing Address - Phone:209-521-9012
Mailing Address - Fax:
Practice Address - Street 1:2116 EASTWOOD CT
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1439
Practice Address - Country:US
Practice Address - Phone:209-521-9012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WR0006X
CA497158282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1467580977OtherREGISTERED NURSE FIRST ASSISTANTE