Healthcare Provider Details

I. General information

NPI: 1821302712
Provider Name (Legal Business Name): LAURIE A YOUNG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 CLEVELAND AVE N
ROSEVILLE MN
55113-1126
US

IV. Provider business mailing address

11208 WREN ST NW
COON RAPIDS MN
55433-3569
US

V. Phone/Fax

Practice location:
  • Phone: 651-642-1825
  • Fax:
Mailing address:
  • Phone: 763-951-2274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number109610-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: