Healthcare Provider Details

I. General information

NPI: 1588031934
Provider Name (Legal Business Name): TRACY LAUBENSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18740 W BLUEMOUND RD
BROOKFIELD WI
53045-2936
US

IV. Provider business mailing address

5454 FARGO AVE
SKOKIE IL
60077-3210
US

V. Phone/Fax

Practice location:
  • Phone: 414-208-6933
  • Fax:
Mailing address:
  • Phone: 414-208-6933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6612-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: