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General NPI Number Information
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NPI Number | 1285164079
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Entity Type | Individual
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Provider Name | WHITNEY PAGE LAUER
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Gender | Female
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Dates
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Enumeration Date | 06/14/2017
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Last Update Date | 11/15/2017
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Provider Practice Location Address
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Address Line | 1101 NINTH STREET NORTH ESSENTIA HEALTH VIRGINIA CLINIC
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City | VIRGINIA
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State | MN
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Zip | 55792-2329
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Country | US
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Telephone | 218-741-0150
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Fax |
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Provider Business Mailing Address
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Address Line | 400 EAST THIRD STREET ESSENTIA HEALTH DULUTH CLINIC MCL2CRED
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City | DULUTH
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State | MN
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Zip | 55805
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Country | US
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Telephone | 218-786-8319
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3501
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License Number State | MN
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