Provider Demographics
NPI:1417910332
Name:LATHROP, LAURA A (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:LATHROP
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 1:13287 DOWNEY TRL
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5249
Mailing Address - Country:US
Mailing Address - Phone:952-250-4333
Mailing Address - Fax:884-421-1622
Practice Address - Street 1:13287 DOWNEY TRL
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55124-5249
Practice Address - Country:US
Practice Address - Phone:952-250-4333
Practice Address - Fax:884-421-1622
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP1602363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH300231366OtherPTAN
MNH300231366OtherPTAN