Provider Demographics
NPI:1740734748
Name:O'ROURKE, LAURA ANTHONY (NP-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANTHONY
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LEIGH
Other - Last Name:ANTHONY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 WEST GRANT STREET
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55041
Mailing Address - Country:US
Mailing Address - Phone:651-345-3321
Mailing Address - Fax:
Practice Address - Street 1:500 WEST GRANT STREET
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MN
Practice Address - Zip Code:55041-1143
Practice Address - Country:US
Practice Address - Phone:651-345-3321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4674363L00000X
MNCNP 4674363LF0000X
WI7077 - 33363LF0000X
MNCNP4674363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily