Provider Demographics
NPI:1457762627
Name:LAKSONEN, RICHARD PAUL JR (NP-C)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:PAUL
Last Name:LAKSONEN
Suffix:JR
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 6TH ST SE
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58784-4444
Mailing Address - Country:US
Mailing Address - Phone:701-628-2442
Mailing Address - Fax:
Practice Address - Street 1:615 6TH ST SE
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:ND
Practice Address - Zip Code:58784
Practice Address - Country:US
Practice Address - Phone:701-628-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704271458363L00000X
IAA148655363LF0000X
NDR39904363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily