Basic Information
| Provider Information | |||||||||
| NPI: | 1245297076 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAURENZANO | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 319 S MARION AVE | ||||||||
| Address2: | LAKE CITY VAMC | ||||||||
| City: | LAKE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867553016 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 319 S MARION AVE | ||||||||
| Address2: | LAKE CITY VAMC | ||||||||
| City: | LAKE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867553016 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 03/03/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME57037 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 57037 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 12080 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 0483013 | 01 | FL | CIGNA | OTHER | 050613 | 01 | FL | VISTA HEALTHPLAN | OTHER | 080190464 | 01 | FL | MEDICARE RAILROAD | OTHER | 218901 | 01 | FL | AVMED | OTHER |