Healthcare Provider Details

I. General information

NPI: 1689675563
Provider Name (Legal Business Name): PETRA M LAEVEN-SESSIONS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PETRA M MESSICK-LAEVEN M.D.

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 2ND ST PEDIATRIC HOSPITALIST DEPT
NEENAH WI
54956-2883
US

IV. Provider business mailing address

130 2ND ST PEDIATRIC HOSPITALIST DEPT
NEENAH WI
54956-2883
US

V. Phone/Fax

Practice location:
  • Phone: 920-969-7900
  • Fax: 920-969-7979
Mailing address:
  • Phone: 920-969-7900
  • Fax: 920-969-7979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9639
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number62317-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60147163
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: