Provider Demographics
NPI:1790485225
Name:AUSMUS, LAURA JEAN (PMHNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:AUSMUS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25326 CROSS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55037-5433
Mailing Address - Country:US
Mailing Address - Phone:320-385-0986
Mailing Address - Fax:
Practice Address - Street 1:3805 WASHINGTON AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-2141
Practice Address - Country:US
Practice Address - Phone:612-887-6282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9988363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1891031209OtherMSHO
MN1902344591.OtherMEDICA
MN1891031209Medicaid
MN1902344591Medicaid
MN1902344591.OtherBLUE CROSS
MN1902344591.Medicaid