Organization
LIFESPARK MEDICAL GROUP, PA
Active
Organization
LIFESPARK MEDICAL GROUP, PA
Active
Other names
Lifesprk Health
Organization subpart
No
Provider details
NPI number
Authorized official
CATHERINE ANN LAURING APRN, CNP (CEO)
(952) 345-3213
Entity
Organization
Contact information
Practice address
5320 W 23RD ST STE 130, ST LOUIS PARK, MN 55416-1670
(952) 345-8770
(952) 345-8871
Mailing address
5320 W 23RD ST STE 130, ST LOUIS PARK, MN 55416-1670
(952) 345-3213
(952) 345-8871
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
2385
MN
Other
Enumeration date
03/13/2018
Last updated
05/02/2022
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