Healthcare Provider Details

I. General information

NPI: 1639327182
Provider Name (Legal Business Name): MAGGIE LAUFENBERG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2179 4TH ST
WHITE BEAR LAKE MN
55110-3028
US

IV. Provider business mailing address

921 5TH AVE S
LA CROSSE WI
54601-4559
US

V. Phone/Fax

Practice location:
  • Phone: 651-705-7872
  • Fax:
Mailing address:
  • Phone: 608-782-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14479
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5532-23
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1372
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: