Healthcare Provider Details

I. General information

NPI: 1215869847
Provider Name (Legal Business Name): LAUREN VOSTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N BROADWAY STE 206
DE PERE WI
54115-2557
US

IV. Provider business mailing address

1000 MIDWAY RD
MENASHA WI
54952-1116
US

V. Phone/Fax

Practice location:
  • Phone: 920-257-2000
  • Fax: 920-257-2004
Mailing address:
  • Phone: 920-257-2000
  • Fax: 920-257-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17763-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: