Basic Information
Provider Information
NPI: 1003143926
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HERMANN
FirstName: LAURA
MiddleName: JEAN
NamePrefix:  
NameSuffix:  
Credential: M.A., RN-BSN, CNS-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
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: 11/13/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
364SA2200XR 162032-4MNY Physician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health

No ID Information.


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