Basic Information
| Provider Information | |||||||||
| NPI: | 1386064111 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIEGLER | ||||||||
| FirstName: | LAURA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1983 SLOAN PLACE, STE 1 | ||||||||
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| City: | ST PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551172520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513265715 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1983 SLOAN PL STE 1 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513265700 | ||||||||
| FaxNumber: | 6513265715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2014 | ||||||||
| LastUpdateDate: | 08/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 59390 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 41-1765832 | 05 | MN | MEDICAID |