Provider Demographics
NPI:1245034420
Name:WEITNAUER, LAUREN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:WEITNAUER
Suffix:
Gender:
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35139 445TH AVE
Mailing Address - Street 2:
Mailing Address - City:AITKIN
Mailing Address - State:MN
Mailing Address - Zip Code:56431-5029
Mailing Address - Country:US
Mailing Address - Phone:218-251-4982
Mailing Address - Fax:
Practice Address - Street 1:35139 445TH AVE
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-5029
Practice Address - Country:US
Practice Address - Phone:218-251-4982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225121-3163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice