Provider Demographics
NPI:1609156983
Name:QUISTORFF, LAURETTE JANE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:LAURETTE
Middle Name:JANE
Last Name:QUISTORFF
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38946 YORKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:SAUK CENTRE
Mailing Address - State:MN
Mailing Address - Zip Code:56378-8326
Mailing Address - Country:US
Mailing Address - Phone:320-352-6290
Mailing Address - Fax:
Practice Address - Street 1:38946 YORKSHIRE ROAD
Practice Address - Street 2:
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56378-8326
Practice Address - Country:US
Practice Address - Phone:320-252-1882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR115056-4163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse