Healthcare Provider Details

I. General information

NPI: 1467580977
Provider Name (Legal Business Name): LAURENCE NORDIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 EASTWOOD CT
MODESTO CA
95355-1439
US

IV. Provider business mailing address

2116 EASTWOOD CT
MODESTO CA
95355-1439
US

V. Phone/Fax

Practice location:
  • Phone: 209-521-9012
  • Fax:
Mailing address:
  • Phone: 209-521-9012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number497158
License Number StateCA

VIII. Authorized Official

Name: MRS. LAURENCE C NORDIN
Title or Position: FIRST ASSISTANTE
Credential: RNFA
Phone: 209-526-4500