MEDICARE: LAURIE MALM-GERHARDSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	R 136488-4	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5900010	OTHER	MN	MEDICA
2	181585	OTHER	MN	UCARE MN PCA
3	4J19CA	OTHER	MN	BCBS
4	106502	OTHER	MN	UCARE MN
5	37865	OTHER	MN	HEALTH PARTNERS

General Provider Information

NPI Number	:	1790816668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE MALM-GERHARDSON

Provider Business Mailing Address
First Line	:	7246 TYLER RD
Second Line	:
City	:	SIREN
State	:	WI
Zip	:	54872-9276
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1953 UNIVERSITY AVE W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-3427
Country	:	US
Telephone Number	:	651-659-0208
Fax Number	:	651-659-0161

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/09/2007

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Directions to “ LAURIE MALM-GERHARDSON ” Practice Location

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