Provider Demographics
NPI:1386064111
Name:GIEGLER, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GIEGLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1983 SLOAN PLACE, STE 1
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2520
Mailing Address - Country:US
Mailing Address - Phone:651-326-5715
Mailing Address - Fax:
Practice Address - Street 1:1983 SLOAN PL STE 1
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117
Practice Address - Country:US
Practice Address - Phone:651-326-5700
Practice Address - Fax:651-326-5715
Is Sole Proprietor?:No
Enumeration Date:2014-04-19
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN59390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN41-1765832Medicaid