Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 8860 | WI |
N | 363LF0000X | Nurse Practitioner - Family Medicine | F10180108 | WI |
NPI | 1003372830 |
---|---|
Provider Name | Violet Margaret Laukant |
First Address | Baraboo, WI 53913-1501 |
Second Address | Baraboo, WI 53913-1501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2019 |
Last Update Date | 08/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003372830 | (05) | WI |