Provider Demographics
NPI:1770991770
Name:MAURIZIO, LAURA ARENDT (MS, PA-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ARENDT
Last Name:MAURIZIO
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:ARENDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PA-C
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 195
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-1188
Mailing Address - Fax:
Practice Address - Street 1:909 FULTON ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-4800
Practice Address - Country:US
Practice Address - Phone:612-672-7422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13127363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant