Individual
LAURA GRACE PATTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4151 WILLOWWOOD STREET SE, PRIOR LAKE, MN 55372
(952) 226-2600
(952) 226-2601
Mailing address
4151 WILLOWWOOD STREET SE, PRIOR LAKE, MN 55372
(952) 226-2600
(952) 226-2601
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10619
MN
363AM0700X
Medical Physician Assistant
Primary
10619
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1689805301
NPI
MN
Enumeration date
07/29/2009
Last updated
07/25/2018
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