Individual
LAURA EVENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
61953 251ST AVE, MANTORVILLE, MN 55955-6039
(507) 635-3639
Mailing address
61953 251ST AVE, MANTORVILLE, MN 55955-6039
(507) 635-3639
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
R118187-6
MN
Other
Enumeration date
02/25/2017
Last updated
02/25/2017
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