Healthcare Provider Details

I. General information

NPI: 1346486768
Provider Name (Legal Business Name): LAURA LOU MESENBRINK APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 W VILLARD AVE WFHC GLENDALE FAMILY CENTER
MILWAUKEE WI
53209-4901
US

IV. Provider business mailing address

2400 W VILLARD AVE WFHC GLENDALE FAMILY CENTER
MILWAUKEE WI
53209-4901
US

V. Phone/Fax

Practice location:
  • Phone: 414-527-8348
  • Fax: 414-527-8046
Mailing address:
  • Phone: 414-527-8348
  • Fax: 414-527-8046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3624-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: