Provider Demographics
NPI:1619454907
Name:KERR, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KERR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:MN
Mailing Address - Zip Code:56169-4011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:203 S 2ND ST
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:MN
Practice Address - Zip Code:56169-4011
Practice Address - Country:US
Practice Address - Phone:507-828-9995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA19272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer