=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477540888
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELE ANN LADURON APNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2005
-----------------------------------------------------
Last Update Date | 03/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 340 N GREEN BAY AVE SUITE 1
-----------------------------------------------------
City | GILLETT
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54124-9325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-855-2823
-----------------------------------------------------
Fax | 920-855-6343
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 340 N GREEN BAY AVE
-----------------------------------------------------
City | GILLETT
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54124-9325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-855-2823
-----------------------------------------------------
Fax | 920-855-6343
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1075-033
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------