Provider Demographics
NPI:1982742508
Name:WHITE, LAURIE BETH (RN, MT, MLDCDP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:BETH
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN, MT, MLDCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 131ST ST W
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7902
Mailing Address - Country:US
Mailing Address - Phone:612-242-7213
Mailing Address - Fax:
Practice Address - Street 1:14575 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-5722
Practice Address - Country:US
Practice Address - Phone:612-242-7213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR124406-9163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse