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General NPI Number Information
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NPI Number | 1790816668
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Entity Type | Individual
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Provider Name | LAURIE MALM-GERHARDSON
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Gender | Female
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1953 UNIVERSITY AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55104-3427
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Country | US
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Telephone | 651-659-0208
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Fax | 651-659-0161
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Provider Business Mailing Address
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Address Line | 7246 TYLER RD
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City | SIREN
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State | WI
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Zip | 54872-9276
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Country | US
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Telephone |
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | R 136488-4
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License Number State | MN
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