Provider Demographics
NPI:1760477590
Name:STARR, LAURIE PAULINE (MSN ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:PAULINE
Last Name:STARR
Suffix:
Gender:F
Credentials:MSN ARNP
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:PAULINE
Other - Last Name:BEESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, ARNP
Mailing Address - Street 1:2999 TROSETH RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1045
Mailing Address - Country:US
Mailing Address - Phone:651-633-3727
Mailing Address - Fax:
Practice Address - Street 1:13998 MAPLE KNOLL WAY # LL101
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7004
Practice Address - Country:US
Practice Address - Phone:651-348-8851
Practice Address - Fax:763-657-1370
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1593943363LF0000X
MNR1593943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN847080400Medicaid
500002908Medicare ID - Type Unspecified
MN500002908Medicare UPIN
MN847080400Medicaid