Healthcare Provider Details

I. General information

NPI: 1295283075
Provider Name (Legal Business Name): MARIAN LAURA ELIZABETH KEILLOR MSN, APRN, CNM, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA ELIZABETH JOHNSON/HARRELSON RN-C, CLC

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 EXCELSIOR BLVD
SAINT LOUIS PARK MN
55426-4702
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-3282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM 0299
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: