Basic Information
| Provider Information | |||||||||
| NPI: | 1477585370 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | LARA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| Address2: | 420 DELAWARE STREET SE, MMC 742 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126262916 | ||||||||
| FaxNumber: | 6126260413 | ||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| Address2: | 516 DELAWARE STREET SE, PWB FOURTH FLOOR, ROOM 4-100 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126262916 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 12/05/2011 | ||||||||
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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 | 208000000X | 47248 | MN | Y | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0203X | 47248 | MN | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1042757 | 01 | MN | PREFERRED ONE | OTHER | 132491 | 01 | MN | UCARE | OTHER | 809629500 | 05 | MN | MEDICAID | HP48317 | 01 | MN | HEALTHPARTNERS | OTHER | 12-03170 | 01 | MN | MEDICA CHOICE | OTHER | 34608800 | 05 | WI | MEDICAID | 2280061 | 01 | MN | ARAZ | OTHER | 0595652 | 05 | IA | MEDICAID | 12-09026 | 01 | MN | MEDICA PRIMARY | OTHER | 179R3NE | 01 | MN | BCBS | OTHER |