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General NPI Number Information
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NPI Number | 1164316873
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Entity Type | Individual
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Provider Name | CARLY ANN LAUER CNP
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Gender | Female
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 23313 145TH AVE NW
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City | VIKING
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State | MN
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Zip | 56760-9522
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Country | US
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Telephone | 218-201-2253
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Fax |
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Provider Business Mailing Address
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Address Line | 23313 145TH AVE NW
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City | VIKING
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State | MN
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Zip | 56760-9522
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Country | US
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Telephone | 218-201-2253
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 12891
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License Number State | MN
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