Healthcare Provider Details

I. General information

NPI: 1205232626
Provider Name (Legal Business Name): LAUREN P MAYER APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN P GRUBER APNP

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 SHERMAN AVE E
FORT ATKINSON WI
53538-1960
US

IV. Provider business mailing address

PO BOX 249
FORT ATKINSON WI
53538-0249
US

V. Phone/Fax

Practice location:
  • Phone: 920-563-5571
  • Fax:
Mailing address:
  • Phone: 920-563-5571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number6098-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: