Provider Demographics
NPI:1619054327
Name:SPICER, LAURA JOY (WHCNP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JOY
Last Name:SPICER
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:JOY
Other - Last Name:BOHLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6002
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58206-6002
Mailing Address - Country:US
Mailing Address - Phone:701-780-5000
Mailing Address - Fax:
Practice Address - Street 1:1000 SOUTH COLUMBIA ROAD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58206-6002
Practice Address - Country:US
Practice Address - Phone:701-780-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR28830363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDR28830OtherRN APRN NP WHCNP WITH RX
ND53595Medicaid
NDSPI1-0432-6504OtherNCC WHCNP