Provider Demographics
NPI:1912147075
Name:FURDA-RAINE, LAURA MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MICHELLE
Last Name:FURDA-RAINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:952-993-0333
Practice Address - Street 1:3800 PARK NICOLLET BLVD PARK NICOLLET CLINIC
Practice Address - Street 2:
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:952-993-3260
Practice Address - Fax:952-993-0333
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN56316207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology