Healthcare Provider Details

I. General information

NPI: 1497931943
Provider Name (Legal Business Name): LAURA MCKINNIS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA A OKEEFE N.P.

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 WISCONSIN AVE STE 150
GRAFTON WI
53024-2075
US

IV. Provider business mailing address

1505 WISCONSIN AVE STE 150
GRAFTON WI
53024-2075
US

V. Phone/Fax

Practice location:
  • Phone: 262-421-8961
  • Fax:
Mailing address:
  • Phone: 262-421-8961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3279-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code364SE0003X
TaxonomyEmergency Clinical Nurse Specialist
License Number3279-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: