Healthcare Provider Details

I. General information

NPI: 1447068663
Provider Name (Legal Business Name): LAURI ALICIA GEVERINK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2668 HUALAPAI MOUNTAIN RD
KINGMAN AZ
86401-8387
US

IV. Provider business mailing address

2668 HUALAPAI MOUNTAIN RD
KINGMAN AZ
86401-8387
US

V. Phone/Fax

Practice location:
  • Phone: 928-718-7322
  • Fax: 928-753-4998
Mailing address:
  • Phone: 928-718-7322
  • Fax: 928-753-4998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN140250
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: