Provider Demographics
NPI:1639302276
Name:OSTROW, LAUREL GAIL
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:GAIL
Last Name:OSTROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1368 SIMPSON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-2427
Mailing Address - Country:US
Mailing Address - Phone:651-431-0825
Mailing Address - Fax:
Practice Address - Street 1:1368 SIMPSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-2427
Practice Address - Country:US
Practice Address - Phone:651-431-0825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0112764363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health