Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | R170204-8 | MN |
N | 363LG0600X | Nurse Practitioner - Gerontology | R170204-8 | MN |
NPI | 1063784627 |
---|---|
Provider Name | Laura Marie Quigg |
First Address | Burnsville, MN 55337-5714 |
Second Address | Burnsville, MN 55337-5714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2012 |
Last Update Date | 29/01/2012 |