Healthcare Provider Details

I. General information

NPI: 1811638133
Provider Name (Legal Business Name): LAUREN VAN HOVE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 CENTRAL AVE N
WAYZATA MN
55391-1206
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-8250
  • Fax:
Mailing address:
  • Phone: 952-541-2802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number75781
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: