Provider Demographics
NPI:1245297076
Name:LAURENZANO, KATHERINE R (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:R
Last Name:LAURENZANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:319 S MARION AVE
Mailing Address - Street 2:LAKE CITY VAMC
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025
Mailing Address - Country:US
Mailing Address - Phone:386-755-3016
Mailing Address - Fax:
Practice Address - Street 1:319 S MARION AVE
Practice Address - Street 2:LAKE CITY VAMC
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025
Practice Address - Country:US
Practice Address - Phone:386-755-3016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57037207Q00000X
FL57037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12080OtherBLUE CROSS BLUE SHIELD
FL0483013OtherCIGNA
FL050613OtherVISTA HEALTHPLAN
FL080190464OtherMEDICARE RAILROAD
FL218901OtherAVMED
FL080190464OtherMEDICARE RAILROAD
FL12080OtherBLUE CROSS BLUE SHIELD