Provider Demographics
NPI:1689805301
Name:PATTON, LAURA GRACE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:GRACE
Last Name:PATTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:GRACE
Other - Last Name:SATHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4151 WILLOWWOOD STREET SE
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372
Mailing Address - Country:US
Mailing Address - Phone:952-226-2600
Mailing Address - Fax:952-226-2601
Practice Address - Street 1:4151 WILLOWWOOD STREET SE
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372
Practice Address - Country:US
Practice Address - Phone:952-226-2600
Practice Address - Fax:952-226-2601
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10619363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1689805301OtherNPI