Provider Demographics
NPI:1558622548
Name:SOPER, LAURIE LEA (APRN-C)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:LEA
Last Name:SOPER
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:NE
Mailing Address - Zip Code:69154-6152
Mailing Address - Country:US
Mailing Address - Phone:308-772-3283
Mailing Address - Fax:
Practice Address - Street 1:1100 W 2ND ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:NE
Practice Address - Zip Code:69154-6152
Practice Address - Country:US
Practice Address - Phone:308-772-3283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily