Basic Information
Provider Information
NPI: 1629168158
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MACLAURIN
FirstName: DANIELLE
MiddleName: YVONNE
NamePrefix: MS.
NameSuffix:  
Credential: APRN,BC, ANP, GNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 800 E 28TH ST
Address2:  
City: MINNEAPOLIS
State: MN
PostalCode: 554073723
CountryCode: US
TelephoneNumber: 6128636590
FaxNumber: 6128635247
Practice Location
Address1: 800 E 28TH ST
Address2:  
City: MINNEAPOLIS
State: MN
PostalCode: 554073723
CountryCode: US
TelephoneNumber: 6128638293
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/13/2006
LastUpdateDate: 01/13/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XR 135493-3MNY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


Home