Provider Demographics
NPI:1154074649
Name:FODNESS, LAURA J (CNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:FODNESS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MN
Mailing Address - Zip Code:56110-1143
Mailing Address - Country:US
Mailing Address - Phone:507-227-0821
Mailing Address - Fax:
Practice Address - Street 1:1216 RYANS RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-1780
Practice Address - Country:US
Practice Address - Phone:507-372-2921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily