MEDICARE: LAURA MARIE HESS FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	153420-30	WI
2	363LF0000X	Family Nurse Practitioner	5410-33	WI

General Provider Information

NPI Number	:	1245670553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MARIE HESS FNP-BC

Provider Business Mailing Address
First Line	:	302 N JACKSON ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-5904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 S 7TH ST STE 300
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-3538
Country	:	US
Telephone Number	:	414-645-8383
Fax Number	:	414-645-8803

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2013
Last Update Date	:	08/28/2013

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