Healthcare Provider Details

I. General information

NPI: 1023538659
Provider Name (Legal Business Name): LAURIE GEDDES MS, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2017
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 WOODWINDS DR
WOODBURY MN
55125-2522
US

IV. Provider business mailing address

2040 WOODWINDS DR
WOODBURY MN
55125-2522
US

V. Phone/Fax

Practice location:
  • Phone: 651-259-9750
  • Fax:
Mailing address:
  • Phone: 651-259-9750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5210
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: