Provider Demographics
NPI:1447068663
Name:GEVERINK, LAURI ALICIA
Entity type:Individual
Prefix:
First Name:LAURI
Middle Name:ALICIA
Last Name:GEVERINK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2668 HUALAPAI MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-8387
Mailing Address - Country:US
Mailing Address - Phone:928-718-7322
Mailing Address - Fax:928-753-4998
Practice Address - Street 1:2668 HUALAPAI MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-8387
Practice Address - Country:US
Practice Address - Phone:928-718-7322
Practice Address - Fax:928-753-4998
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN140250163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care