Provider Demographics
NPI:1104156132
Name:LASEE, LORI LYNN (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LYNN
Last Name:LASEE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:MISS
Other - First Name:LORI
Other - Middle Name:LYNN
Other - Last Name:DORNACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:W6161 WESTLAKE CT
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54937-1600
Mailing Address - Country:US
Mailing Address - Phone:920-904-2599
Mailing Address - Fax:
Practice Address - Street 1:W6161 WESTLAKE CT
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54937-1600
Practice Address - Country:US
Practice Address - Phone:920-904-2599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI125633-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse