Healthcare Provider Details

I. General information

NPI: 1700740347
Provider Name (Legal Business Name): KELSIE LYNN LAIZURE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CENTRAL AVE N APT 9
VALLEY CITY ND
58072-2946
US

IV. Provider business mailing address

220 CENTRAL AVE N APT 4
VALLEY CITY ND
58072-2946
US

V. Phone/Fax

Practice location:
  • Phone: 701-561-8178
  • Fax:
Mailing address:
  • Phone: 701-840-0620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberKLI889774
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License NumberKLI889774
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: