Healthcare Provider Details

I. General information

NPI: 1730847021
Provider Name (Legal Business Name): LAURA ANDERSON APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6255 UNIVERSITY AVE
MIDDLETON WI
53562-3485
US

IV. Provider business mailing address

5308 HERON TRL
MIDDLETON WI
53562-5215
US

V. Phone/Fax

Practice location:
  • Phone: 608-819-8544
  • Fax: 608-819-8547
Mailing address:
  • Phone: 608-215-1526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11417-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: