Healthcare Provider Details

I. General information

NPI: 1598885709
Provider Name (Legal Business Name): RUTH ANN NELSON-LAU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 W. COLLEGE AVE. STE 200
APPLETON WI
54914-3968
US

IV. Provider business mailing address

40 S MAIN ST STE 1300
MEMPHIS TN
38103-5513
US

V. Phone/Fax

Practice location:
  • Phone: 715-921-9568
  • Fax:
Mailing address:
  • Phone: 866-949-0108
  • Fax: 715-539-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number92551-030
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: