Healthcare Provider Details

I. General information

NPI: 1063094357
Provider Name (Legal Business Name): LAUREN HENRY APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E MAHN CT
OAK CREEK WI
53154-2155
US

IV. Provider business mailing address

1040 N CASS ST UNIT 702
MILWAUKEE WI
53202-3389
US

V. Phone/Fax

Practice location:
  • Phone: 414-762-2020
  • Fax:
Mailing address:
  • Phone: 262-501-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95030137
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number357654
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11038885
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95030137
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10680-33
License Number StateWI
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1191821
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: