Healthcare Provider Details

I. General information

NPI: 1710973508
Provider Name (Legal Business Name): DR. LAURA K FORTNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MARKET ST
BOARDMAN OH
44512-6725
US

IV. Provider business mailing address

400 EAST THIRD STREET ESSENTIA HEALTH DULUTH CLINIC MCL2CRED
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-4350
  • Fax: 330-729-4351
Mailing address:
  • Phone: 218-786-3146
  • Fax: 218-722-8792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number35077776
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number65672
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35077776
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: