Provider Demographics
NPI:1205663184
Name:KULSRUD, LAURA L
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:KULSRUD
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 1:8080 12TH ST NE
Mailing Address - Street 2:
Mailing Address - City:GRACE CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58445-9222
Mailing Address - Country:US
Mailing Address - Phone:701-653-5930
Mailing Address - Fax:
Practice Address - Street 1:8080 12TH ST NE
Practice Address - Street 2:
Practice Address - City:GRACE CITY
Practice Address - State:ND
Practice Address - Zip Code:58445-9222
Practice Address - Country:US
Practice Address - Phone:701-653-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care