Healthcare Provider Details

I. General information

NPI: 1174596795
Provider Name (Legal Business Name): CARRIE L. LAPOW APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S69 W15636 JANESVILLE ROAD PROHEALTH CARE MEDICAL ASSOCIATES
MUSKEGO WI
53150
US

IV. Provider business mailing address

N17 W24100 RIVERWOOD DRIVE SUITE 250 PROHEALTH CARE MEDICAL ASSOCIATES INC
WAUKESHA WI
53188-1177
US

V. Phone/Fax

Practice location:
  • Phone: 262-928-7000
  • Fax: 414-422-2075
Mailing address:
  • Phone: 262-928-4100
  • Fax: 262-928-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number112622
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2303
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: