Most Relevant Information
Provider Data
| NPI Number: | 1003236704 |
| Provider Name: | LAURA WOODBECK MOUSTAFA |
| Entity Type: | Individual |
| Taxonomy Code: | 208000000X |
| Specialty: | Pediatrics |
| License Number: | 61732 |
Most Important Dates
| Enumeration Date: | 04/21/2014 |
| Last Updated: | 05/11/2021 |
Provider Practice Location
12720 BASS LAKE RD
MAPLE GROVE
MN
553696307
Practice Location Phone/Fax
| Phone: | 7635592861 |
| Fax: |
Provider Mailing Location
12720 BASS LAKE RD
MAPLE GROVE
MN
553696307
Provider Mailing Phone/Fax
| Phone: | 7635592861 |
| Fax: |
Suggested EMR
Pediatrics EMR