Provider Demographics
NPI:1295283075
Name:KEILLOR, MARIAN LAURA ELIZABETH (MSN, APRN, CNM, CLC)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:LAURA ELIZABETH
Last Name:KEILLOR
Suffix:
Gender:
Credentials:MSN, APRN, CNM, CLC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ELIZABETH
Other - Last Name:JOHNSON/HARRELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN-C, CLC
Mailing Address - Street 1:1700 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2945 HAZELWOOD ST STE 100
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1242
Practice Address - Country:US
Practice Address - Phone:651-232-7800
Practice Address - Fax:651-232-7940
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNM 0299367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife