LAURIE JO BLACK RN CNP NPI 1679551329

NPI Information

NPI: 1679551329
Provider Name: LAURIE JO BLACK, RN CNP
Classification: Nurse Practitioner - 363LP0200X
Entity Type: Individual

Specialization: Pediatrics

PECOS Registration: Yes

Address:
1200 6TH AVE N
CENTRA CARE CLINIC
SAINT CLOUD, MN
ZIP 56303
Phone: (320) 251-2700
Get Directions

Laurie Jo Black, RN CNP is a pediatrics nurse practitioner in Saint Cloud, MN. Laurie Jo Black, RN CNP NPI is 1679551329. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1200 6TH AVE N
CENTRA CARE CLINIC
SAINT CLOUD, MN
ZIP 56303-735
Phone: (320) 251-2700
Fax: (727) 587-7739

The NPI 1679551329 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/4/2006 and was last updated on 11/20/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0200X	Nurse Practitioner	Pediatrics	ARNP2638602	FLORIDA	No
2	363LP0200X	Nurse Practitioner	Pediatrics	R217274-5	MINNESOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0307418800	MEDICAID	FLORIDA
2	GC696Z	MEDICARE PIN	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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