MEDICARE: LAURA A LATHROP NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	CNP1602	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	H300231366	OTHER	MN	PTAN

General Provider Information

NPI Number	:	1417910332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA A LATHROP NP

Provider Business Mailing Address
First Line	:	13287 DOWNEY TRL
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55124-5249
Country	:	US
Telephone Number	:	952-250-4333
Fax Number	:	884-421-1622

Provider Business Practice Location Address
First Line	:	13287 DOWNEY TRL
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55124-5249
Country	:	US
Telephone Number	:	952-250-4333
Fax Number	:	884-421-1622

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	11/10/2016

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