Healthcare Provider Details

I. General information

NPI: 1740645019
Provider Name (Legal Business Name): KENDRA LAURUHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 E 20TH PL STE 400
SCOTTSBLUFF NE
69361-2708
US

IV. Provider business mailing address

1930 E 20TH PL STE 400
SCOTTSBLUFF NE
69361-2708
US

V. Phone/Fax

Practice location:
  • Phone: 308-633-2866
  • Fax: 308-633-2874
Mailing address:
  • Phone: 308-633-2866
  • Fax: 308-633-2874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2593
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number120
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: