Individual
LAURA HATHAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
2000 PLYMOUTH RD, MINNETONKA, MN 55305-2366
(952) 593-9818
(952) 593-5187
Mailing address
12720 HOMESTEAD DR, WHITE BEAR LAKE, MN 55110-6041
(651) 407-0576
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9217
MN
Other
Enumeration date
06/09/2006
Last updated
07/08/2007
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