Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | APN0000018785 | TN |
NPI | 1255747648 |
---|---|
Provider Name | Laura Leatherman-Clark |
First Address | Minneapolis, MN 55407-2639 |
Second Address | Woodbury, MN 55125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2014 |
Last Update Date | 10/07/2018 |