Provider Demographics
NPI:1093096927
Name:WILNER, LAURA J (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:WILNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 BELSLY BLVD # 2
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5057
Mailing Address - Country:US
Mailing Address - Phone:218-236-7145
Mailing Address - Fax:
Practice Address - Street 1:803 BELSLY BLVD # 2
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5057
Practice Address - Country:US
Practice Address - Phone:218-236-7145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR181533-3363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health