Provider Demographics
NPI:1861468084
Name:LASACK, LAURA ELLEN (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ELLEN
Last Name:LASACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ELLEN
Other - Last Name:WOOLDRIDGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1215 DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-5400
Mailing Address - Country:US
Mailing Address - Phone:515-239-4400
Mailing Address - Fax:
Practice Address - Street 1:421 E MERLE HIBBS BLVD
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-0000
Practice Address - Country:US
Practice Address - Phone:641-752-0099
Practice Address - Fax:641-752-8736
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002021177207Q00000X
IA34199207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH46092Medicare UPIN