Healthcare Provider Details

I. General information

NPI: 1063452712
Provider Name (Legal Business Name): LAURA J. HERRMANN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PARK AVE
MINNEAPOLIS MN
55415-1623
US

IV. Provider business mailing address

3869 FOX TRL
ST BONIFACIUS MN
55375-1214
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-3000
  • Fax:
Mailing address:
  • Phone: 952-210-8600
  • Fax: 972-400-8223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR093100-1
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR93100-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: