Healthcare Provider Details

I. General information

NPI: 1285164079
Provider Name (Legal Business Name): WHITNEY PAGE LAUER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 NINTH STREET NORTH ESSENTIA HEALTH VIRGINIA CLINIC
VIRGINIA MN
55792-2329
US

IV. Provider business mailing address

400 EAST THIRD STREET ESSENTIA HEALTH DULUTH CLINIC MCL2CRED
DULUTH MN
55805
US

V. Phone/Fax

Practice location:
  • Phone: 218-741-0150
  • Fax:
Mailing address:
  • Phone: 218-786-8319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3501
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: