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General NPI Number Information
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NPI Number | 1942502281
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Entity Type | Individual
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Provider Name | LAURIE BONITA AGRIMSON FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/18/2010
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Last Update Date | 11/18/2010
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Provider Practice Location Address
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Address Line | 45 W. 10TH STREET
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City | ST PAUL
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State | MN
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Zip | 55102
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Country | US
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Telephone | 651-232-3132
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Fax | 651-232-3512
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Provider Business Mailing Address
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Address Line | 1077 ROBERT STREET SOUTH
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City | WEST ST PAUL
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State | MN
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Zip | 55118-1245
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Country | US
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Telephone | 651-455-6302
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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 | 2010008730
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License Number State | MN
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