Provider Demographics
NPI:1619286184
Name:O'LEARY, LAURIE CLAUSSEN (CRNA)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:CLAUSSEN
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:MN
Mailing Address - Zip Code:56215-1653
Mailing Address - Country:US
Mailing Address - Phone:320-843-4232
Mailing Address - Fax:
Practice Address - Street 1:1815 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:MN
Practice Address - Zip Code:56215-1653
Practice Address - Country:US
Practice Address - Phone:320-843-4232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1648827163W00000X
MN9048363LF0000X
MN687367500000X
MNR164882-7367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily