Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 5552-33 | WI |
NPI | 1174951115 |
---|---|
Provider Name | Laurie B Schaefgen |
First Address | Milwaukee, WI 53201-1997 |
Second Address | Wauwatosa, WI 53226-4874 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2013 |
Last Update Date | 30/10/2013 |