Individual
LAURA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP, DNP-FNP
Contact information
Practice address
14040 NORTHDALE BLVD, ROGERS, MN 55374-9612
(763) 488-4100
Mailing address
13060 42ND AVE SW, PILLAGER, MN 56473-2495
(763) 291-5193
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
10747
MN
Other
Enumeration date
11/16/2023
Last updated
11/16/2023
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