Healthcare Provider Details

I. General information

NPI: 1063091171
Provider Name (Legal Business Name): CYNTHIA ANN LALUZERNE APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA ANN FARRELL APNP

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 JEFFERSON ST
ALGOMA WI
54201-1733
US

IV. Provider business mailing address

323 S 18TH AVE
STURGEON BAY WI
54235-1401
US

V. Phone/Fax

Practice location:
  • Phone: 920-487-3496
  • Fax: 920-487-0275
Mailing address:
  • Phone: 920-743-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10522
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: