Active NPI
Laura Hathaway, P.A.
- Physician Assistant
- Minnetonka, MN
National Provider Identifier
1780625723
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 9217
- Practice address
- 2000 Plymouth Rd
Minnetonka, MN 55305-2366 - Phone
- (952) 593-9818
- Fax
- (952) 593-5187
- NPI assigned
- Jun 9, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 9217 | MN | Primary |
Addresses
Primary practice location
2000 Plymouth Rd
Minnetonka, MN 55305-2366
Mailing address
12720 Homestead Dr
White Bear Lake, MN 55110-6041
Phone (651) 407-0576
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9217 | MN | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780625723",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12720 HOMESTEAD DR",
"city": "WHITE BEAR LAKE",
"state": "MN",
"postal_code": "551106041",
"telephone_number": "651-407-0576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 PLYMOUTH RD",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553052366",
"telephone_number": "952-593-9818",
"fax_number": "952-593-5187"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HATHAWAY",
"first_name": "LAURA",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "9217",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.