Healthcare Provider Details

I. General information

NPI: 1750479291
Provider Name (Legal Business Name): LAURIE DOROTHY SOROKEN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 COURTHOUSE LANE SUITE 9
CHELMSFORD MA
01824
US

IV. Provider business mailing address

25 CIRCLE ROAD
LOWELL MA
01852
US

V. Phone/Fax

Practice location:
  • Phone: 978-459-8400
  • Fax:
Mailing address:
  • Phone: 978-459-8400
  • Fax: 978-459-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number190951
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: