Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 10105522-1205 | UT |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 69535 | MN |
NPI | 1053799031 |
---|---|
Provider Name | Dr. Laura Christensen Waller |
First Address | Duluth, MN 55805-1951 |
Second Address | Duluth, MN 55805-1951 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2015 |
Last Update Date | 18/08/2021 |