Healthcare Provider Details

I. General information

NPI: 1609715457
Provider Name (Legal Business Name): LAURA WOJTAK APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14715 BRAUN RD
STURTEVANT WI
53177-3016
US

IV. Provider business mailing address

14715 BRAUN RD
STURTEVANT WI
53177-3016
US

V. Phone/Fax

Practice location:
  • Phone: 262-358-1842
  • Fax:
Mailing address:
  • Phone: 262-358-1842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number18213-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: