Individual
LAURIE JO BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN CNP
Contact information
Practice address
1200 6TH AVE N, CENTRA CARE CLINIC, SAINT CLOUD, MN 56303-2735
(320) 251-2700
(727) 587-7739
Mailing address
1200 6TH AVE N, CENTRA CARE CLINIC, SAINT CLOUD, MN 56303-2735
(320) 251-2700
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
ARNP2638602
FL
363LP0200X
Pediatric Nurse Practitioner
Primary
R217274-5
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0307418800
—
FL
Enumeration date
01/04/2006
Last updated
11/20/2014
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