Provider Demographics
NPI:1801246822
Name:LORENSO, ETSEGENET
Entity type:Individual
Prefix:
First Name:ETSEGENET
Middle Name:
Last Name:LORENSO
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 1:903 180TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-8245
Mailing Address - Country:US
Mailing Address - Phone:206-372-4066
Mailing Address - Fax:425-582-2653
Practice Address - Street 1:903 180TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-8245
Practice Address - Country:US
Practice Address - Phone:206-372-4066
Practice Address - Fax:425-582-2653
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60158541163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse