Healthcare Provider Details

I. General information

NPI: 1548680259
Provider Name (Legal Business Name): LAURA PIENTKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR # 116A
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

1 VETERANS DR # 116A
MINNEAPOLIS MN
55417-2309
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-4675
  • Fax:
Mailing address:
  • Phone: 612-467-4010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number59963
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number59963
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: