Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | R181533-3 | MN |
NPI | 1093096927 |
---|---|
Provider Name | Laura J Wilner |
First Address | Moorhead, MN 56560-5057 |
Second Address | Moorhead, MN 56560-5057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2011 |
Last Update Date | 06/09/2011 |