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General NPI Number Information
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NPI Number | 1992862551
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Entity Type | Individual
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Provider Name | LAURA LYNN RAFTERY M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 721 AMERICAN AVE STE 108 PROHEALTH CARE REGIONAL CANCER CENTER
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City | WAUKESHA
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State | WI
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Zip | 53188-5071
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Country | US
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Telephone | 262-928-2570
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Fax |
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Provider Business Mailing Address
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Address Line | 721 AMERICAN AVE STE 108 PROHEALTH CARE REGIONAL CANCER CENTER
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City | WAUKESHA
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State | WI
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Zip | 53188-5071
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Country | US
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Telephone | 262-928-2570
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 125737
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 00296
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 57928
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License Number State | WI
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