Healthcare Provider Details

I. General information

NPI: 1821284746
Provider Name (Legal Business Name): LARA THOMAS OLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LARA ELIZABETH THOMAS

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 FRANCE AVENUE S
EDINA MN
55435
US

IV. Provider business mailing address

3452 EDGEWOOD AVENUE S
ST. LOUIS PARK MN
55426
US

V. Phone/Fax

Practice location:
  • Phone: 952-924-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR1580998
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: