Provider Demographics
NPI:1942502281
Name:AGRIMSON, LAURIE BONITA (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:BONITA
Last Name:AGRIMSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:LAURIE
Other - Middle Name:BONITA
Other - Last Name:AGRIMSON-HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1077 ROBERT STREET SOUTH
Mailing Address - Street 2:
Mailing Address - City:WEST ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-1245
Mailing Address - Country:US
Mailing Address - Phone:651-455-6302
Mailing Address - Fax:
Practice Address - Street 1:45 W. 10TH STREET
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-232-3132
Practice Address - Fax:651-232-3512
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2010008730363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner