Provider Demographics
NPI:1932470002
Name:SORENSON, LAURI LEANN (RN)
Entity Type:Individual
Prefix:MS
First Name:LAURI
Middle Name:LEANN
Last Name:SORENSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-2630
Mailing Address - Country:US
Mailing Address - Phone:605-645-2005
Mailing Address - Fax:
Practice Address - Street 1:145 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2630
Practice Address - Country:US
Practice Address - Phone:605-645-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-22
Last Update Date:2012-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD-RN R019040163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse