Healthcare Provider Details

I. General information

NPI: 1164885661
Provider Name (Legal Business Name): LAURA MARIE LENIUS CO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 25TH AVE S
MINNEAPOLIS MN
55454-1513
US

IV. Provider business mailing address

420 DELAWARE ST SE MMC 493
MINNEAPOLIS MN
55455-0341
US

V. Phone/Fax

Practice location:
  • Phone: 612-365-6777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1900X
TaxonomyOrthoptist
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: