Basic Information
Provider Information
NPI: 1083023899
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WINTERS
FirstName: LAURA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RN, CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
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Mailing Information
Address1: 400 E 3RD ST
Address2: ESSENTIA HEALTH DULUTH CLINIC
City: DULUTH
State: MN
PostalCode: 558051951
CountryCode: US
TelephoneNumber: 2187868364
FaxNumber:  
Practice Location
Address1: 197 PIEDMONT BLVD STE 100
Address2:  
City: ROCK HILL
State: SC
PostalCode: 297321825
CountryCode: US
TelephoneNumber: 8033241950
FaxNumber: 8033241933
Other Information
ProviderEnumerationDate: 08/06/2014
LastUpdateDate: 09/23/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/23/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XR-187911-7MNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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