Provider Demographics
NPI:1548096019
Name:ANDERTON, LAURA UTZ (NP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:UTZ
Last Name:ANDERTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CARLSON PKWY N STE 100
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-4467
Mailing Address - Country:US
Mailing Address - Phone:952-473-1286
Mailing Address - Fax:
Practice Address - Street 1:2 CARLSON PKWY N STE 100
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-4467
Practice Address - Country:US
Practice Address - Phone:952-473-1286
Practice Address - Fax:952-473-7281
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN11505363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner