Individual provider · NPI-1

Laurie Jo Black, RN CNP

Nurse Practitioner, Pediatrics · Saint Cloud, MN

NPI number1679551329
StatusActive
Last updated in NPPESNov 20, 2014

Details

NPI
1679551329
Entity type
Individual (NPI-1)
Name
Laurie Jo Black
Credential
RN CNP
Sex
Female
Sole proprietor
No
Enumeration date
Jan 4, 2006
Last updated
Nov 20, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LP0200X Nurse Practitioner, PediatricsR217274-5MNYes
363LP0200X Nurse Practitioner, PediatricsARNP2638602FL

Other names

  • Laurie Jo Pereira (Other Name)

Practice location

1200 6th Ave N
Centra Care Clinic
Saint Cloud, MN 56303-2735

Phone 320-251-2700 · Fax 727-587-7739

Mailing address

1200 6th Ave N
Centra Care Clinic
Saint Cloud, MN 56303-2735

Phone 320-251-2700

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