Provider Demographics
NPI:1740645019
Name:LAURUHN, KENDRA
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:LAURUHN
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 1:1930 E 20TH PL STE 400
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-2708
Mailing Address - Country:US
Mailing Address - Phone:308-633-2866
Mailing Address - Fax:308-633-2874
Practice Address - Street 1:1930 E 20TH PL STE 400
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-2708
Practice Address - Country:US
Practice Address - Phone:308-633-2866
Practice Address - Fax:308-633-2874
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2593124Q00000X
NE120124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist