Healthcare Provider Details

I. General information

NPI: 1225721277
Provider Name (Legal Business Name): BRIGITTE MARIE LAABS APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 N GRANDVIEW BLVD
WAUKESHA WI
53188-6105
US

IV. Provider business mailing address

676 DAFFODIL CT
OCONOMOWOC WI
53066-2325
US

V. Phone/Fax

Practice location:
  • Phone: 262-549-6600
  • Fax:
Mailing address:
  • Phone: 414-469-2804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13825-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: