Provider Demographics
NPI:1215667308
Name:LAUCKNER, LISA M
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:LAUCKNER
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 1:11810 64TH ST SW
Mailing Address - Street 2:
Mailing Address - City:NEW ENGLAND
Mailing Address - State:ND
Mailing Address - Zip Code:58647-9413
Mailing Address - Country:US
Mailing Address - Phone:701-205-8143
Mailing Address - Fax:
Practice Address - Street 1:11810 64TH ST SW
Practice Address - Street 2:
Practice Address - City:NEW ENGLAND
Practice Address - State:ND
Practice Address - Zip Code:58647-9413
Practice Address - Country:US
Practice Address - Phone:701-205-8143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide