Healthcare Provider Details

I. General information

NPI: 1487573515
Provider Name (Legal Business Name): LAURA ANDERSON APNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 FORD ST STE A
KIMBERLY WI
54136-2216
US

IV. Provider business mailing address

740 FORD ST STE A
KIMBERLY WI
54136-2216
US

V. Phone/Fax

Practice location:
  • Phone: 920-939-3800
  • Fax:
Mailing address:
  • Phone: 920-939-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18693-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: