Provider Demographics
NPI:1518975119
Name:WALSH, LAURIE KATHRYN (RN, CNP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:KATHRYN
Last Name:WALSH
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 FRANCE AVE S STE 107
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4738
Mailing Address - Country:US
Mailing Address - Phone:952-832-5252
Mailing Address - Fax:952-548-5254
Practice Address - Street 1:7400 FRANCE AVE S STE 107
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4738
Practice Address - Country:US
Practice Address - Phone:952-832-5252
Practice Address - Fax:952-548-5254
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR133624-9363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP30943Medicare UPIN