Provider Demographics
NPI:1376968537
Name:DICK, LAUREN MARIE (AGNP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MARIE
Last Name:DICK
Suffix:
Gender:F
Credentials:AGNP
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Mailing Address - Street 1:5980 143RD LN NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-5616
Mailing Address - Country:US
Mailing Address - Phone:651-307-9772
Mailing Address - Fax:952-993-2631
Practice Address - Street 1:6500 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4702
Practice Address - Country:US
Practice Address - Phone:952-993-2651
Practice Address - Fax:952-993-2631
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2014-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR 180090-8363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner