Individual
LAURA A MICKELSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
14800 KELLEHER CT, SAVAGE, MN 55378-2996
(612) 280-3782
Mailing address
14800 KELLEHER CT, SAVAGE, MN 55378-2996
(612) 280-3782
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
#682114
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
R 125293-8
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43406700
—
WI
Enumeration date
03/23/2006
Last updated
07/09/2007
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