Provider Demographics
NPI:1992734826
Name:LAGAARD, MARY WATZKA (RN, CNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:WATZKA
Last Name:LAGAARD
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 313TH LN NE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-6869
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9701 DATA PARK
Practice Address - Street 2:MN006-W600
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9026
Practice Address - Country:US
Practice Address - Phone:800-896-8936
Practice Address - Fax:888-866-3209
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2009-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR093850-9363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNS43004Medicare UPIN