Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 7149 | MN |
N | 363LA2100X | Nurse Practitioner - Acute Care | 7149 | MN |
NPI | 1013556489 |
---|---|
Provider Name | Lara Louise Beacom |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2020 |
Last Update Date | 24/05/2021 |