Provider Demographics
NPI:1982047593
Name:IVERSON, LAURA JEAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JEAN
Last Name:IVERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:JEAN
Other - Last Name:NYGAARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4563 154TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-8666
Mailing Address - Country:US
Mailing Address - Phone:701-426-6404
Mailing Address - Fax:
Practice Address - Street 1:4563 154TH AVE NW
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-8666
Practice Address - Country:US
Practice Address - Phone:701-426-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics