Laura Woodbeck Moustafa
Pediatrician
12720 Bass Lake Rd
Maple Grove
, Minnesota 55369-6307
Laura Woodbeck Moustafa
Pediatrician
12720 Bass Lake Rd
Maple Grove
, Minnesota 55369-6307
(763) 559-2861
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About
Features
Specialties
- Pediatrician
Languages spoken
- English
Location
First Address
- Laura Woodbeck Moustafa
- 12720 Bass Lake Rd
- Maple Grove, MN
- Zip : 55369-6307
- Phone : (763) 559-2861
Second Address
- Laura Woodbeck Moustafa
- 12720 Bass Lake Rd
- Maple Grove, MN
- Zip : 55369-6307
- Phone : (763) 559-2861
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 208000000X | Pediatrician | 61732 | MN |
National Provider Identifier
| NPI | 1003236704 |
|---|---|
| Provider Name | Laura Woodbeck Moustafa |
| First Address | Maple Grove, MN 55369-6307 |
| Second Address | Maple Grove, MN 55369-6307 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 21/04/2014 |
| Last Update Date | 11/05/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.