Provider Demographics
NPI:1629143359
Name:NESPBOR, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:NESPBOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:8170 33RD AVE S - MS 21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-552-2600
Mailing Address - Fax:651-552-2614
Practice Address - Street 1:5625 CENEX DR
Practice Address - Street 2:MAIL STOP 33100A
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55077-1735
Practice Address - Country:US
Practice Address - Phone:651-552-2600
Practice Address - Fax:651-552-2614
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN081320600OtherMEDICAL ASSISTANCE
MN167714Medicare UPIN
MN600004707Medicare UPIN
MN24618TKMedicare UPIN
MN6239666Medicare UPIN
MN1022884Medicare UPIN
MNHP40479Medicare UPIN