Basic Information
| Provider Information | |||||||||
| NPI: | 1942277165 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAURING | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | WASECA MEDICAL CENTER - MAYO HEALTH SYSTEM | ||||||||
| Address2: | 501 N STATE ST | ||||||||
| City: | WASECA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5078351210 | ||||||||
| FaxNumber: | 5078373949 | ||||||||
| Practice Location | |||||||||
| Address1: | WASECA MEDICAL CENTER - MAYO HEALTH SYSTEM | ||||||||
| Address2: | 501 N STATE ST | ||||||||
| City: | WASECA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5078351210 | ||||||||
| FaxNumber: | 5078373949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 24809 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2M073LA | 01 | MN | BCBS | OTHER | CN7693 | 01 | MN | MEDICARE - RAILROAD | OTHER | HP16606 | 01 | MN | HEALTH PARTNERS | OTHER | NA9501014021 | 01 | MN | PREFERRED ONE | OTHER | 2M037LA | 01 | MN | BCBS | OTHER | 39-09161 | 01 | MN | MEDICA | OTHER | 0112735 | 01 | MN | MEDICA | OTHER | 114665 | 01 | MN | MNCARE - U | OTHER |