Basic Information
| Provider Information | |||||||||
| NPI: | 1003143926 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERMANN | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | M.A., RN-BSN, CNS-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1075 CHURCHILL CT | ||||||||
| Address2: | |||||||||
| City: | SHOREVIEW | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551265903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514849231 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 225 SMITH AVE N | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551022533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517266338 | ||||||||
| FaxNumber: | 6517260366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2009 | ||||||||
| LastUpdateDate: | 03/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SA2200X | R 162032-4 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health |
No ID Information.