Provider Demographics
NPI:1699063669
Name:LASORSA, JENNIFER RESLI (M,SW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RESLI
Last Name:LASORSA
Suffix:
Gender:F
Credentials:M,SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W 1ST ST
Mailing Address - Street 2:STE.200
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-5675
Mailing Address - Country:US
Mailing Address - Phone:775-677-2216
Mailing Address - Fax:
Practice Address - Street 1:900 W 1ST ST
Practice Address - Street 2:STE.200
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-5675
Practice Address - Country:US
Practice Address - Phone:775-677-2216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker