Healthcare Provider Details

I. General information

NPI: 1659296564
Provider Name (Legal Business Name): LAUREEN ELVERA MAHONEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 9TH ST N
VIRGINIA MN
55792-2325
US

IV. Provider business mailing address

806 14TH ST N
VIRGINIA MN
55792-2253
US

V. Phone/Fax

Practice location:
  • Phone: 218-305-0000
  • Fax:
Mailing address:
  • Phone: 218-305-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1039546
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: