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General NPI Number Information
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NPI Number | 1710604061
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Entity Type | Individual
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Provider Name | LAURA J BRADSTREET APNP
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Gender | Female
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Dates
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Enumeration Date | 10/26/2022
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 619 WINDLACH ST
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City | NEW GLARUS
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State | WI
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Zip | 53574-9439
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Country | US
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Telephone | 414-412-0427
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Fax |
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Provider Business Mailing Address
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Address Line | 619 WINDLACH ST
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City | NEW GLARUS
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State | WI
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Zip | 53574-9439
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Country | US
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Telephone | 414-412-0427
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 13111
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License Number State | WI
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