Healthcare Provider Details

I. General information

NPI: 1306833348
Provider Name (Legal Business Name): LAURA LEE STRESOW RN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SILVER LAKE RD NW 110
NEW BRIGHTON MN
55112-1786
US

IV. Provider business mailing address

1900 SILVER LAKE RD NW 110
NEW BRIGHTON MN
55112-1786
US

V. Phone/Fax

Practice location:
  • Phone: 651-628-9566
  • Fax: 651-628-0411
Mailing address:
  • Phone: 651-379-1718
  • Fax: 651-379-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR1271650
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: