Healthcare Provider Details

I. General information

NPI: 1588081913
Provider Name (Legal Business Name): LAURA W O'LOUGHLIN APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 N PROSPECT AVE PROSPECT MEDICAL COMMONS
MILWAUKEE WI
53211-4445
US

IV. Provider business mailing address

2675 N MAYFAIR RD STE 400
MILWAUKEE WI
53226-1305
US

V. Phone/Fax

Practice location:
  • Phone: 414-319-3000
  • Fax:
Mailing address:
  • Phone: 414-763-6910
  • Fax: 414-763-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5641
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5641-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: