Healthcare Provider Details

I. General information

NPI: 1184969586
Provider Name (Legal Business Name): LAUREN A GUHL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 W WATERTOWN PLANK RD
MILWAUKEE WI
53226
US

IV. Provider business mailing address

8700 W WATERTOWN PLANK RD
MILWAUKEE WI
53226-3595
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-7100
  • Fax: 414-805-7171
Mailing address:
  • Phone: 414-805-7100
  • Fax: 414-805-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.004522
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4303
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: