Provider Demographics
NPI:1255518346
Name:LAURSEN, AMY (RN, BSN)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:LAURSEN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1791
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537-1791
Mailing Address - Country:US
Mailing Address - Phone:541-941-4377
Mailing Address - Fax:
Practice Address - Street 1:3439 AGATE MDWS
Practice Address - Street 2:
Practice Address - City:WHITE CITY
Practice Address - State:OR
Practice Address - Zip Code:97503-1589
Practice Address - Country:US
Practice Address - Phone:541-826-9460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health