Healthcare Provider Details

I. General information

NPI: 1356446520
Provider Name (Legal Business Name): LAUREL L DENHEIJER APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREL L SICKINGER APNP

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 ELIZA ST
GREEN BAY WI
54301-3234
US

IV. Provider business mailing address

PO BOX 22487
GREEN BAY WI
54305-2487
US

V. Phone/Fax

Practice location:
  • Phone: 920-965-4800
  • Fax: 920-965-4801
Mailing address:
  • Phone: 920-445-7226
  • Fax: 920-445-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1597003
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1597-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: