Provider Demographics
NPI:1205909629
Name:FLERCHINGER, LAURENCE (RN)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:
Last Name:FLERCHINGER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19924 WINDY LANE
Mailing Address - Street 2:
Mailing Address - City:LENORE
Mailing Address - State:ID
Mailing Address - Zip Code:83541
Mailing Address - Country:US
Mailing Address - Phone:208-836-5680
Mailing Address - Fax:
Practice Address - Street 1:111 BEVER GRADE RD
Practice Address - Street 2:
Practice Address - City:LAPWAY
Practice Address - State:ID
Practice Address - Zip Code:83540
Practice Address - Country:US
Practice Address - Phone:208-843-2271
Practice Address - Fax:208-843-2658
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN28974163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse