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NPI Code Detail

MEDICARE: MICHELE ANN LADURON APNP

MEDICARE: MICHELE ANN LADURON APNP
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
1363LF0000XFamily Nurse Practitioner1075-033WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1390848401050OTHERWICMH ANTHEM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31851477913OTHERWICMH NPI
41134250905OTHERWIGPCC NPI

General Provider Information

NPI Number : 1477540888
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELE ANN LADURON APNP
Provider Business Mailing Address
First Line : 340 N GREEN BAY AVE
Second Line :
City : GILLETT
State : WI
Zip : 54124-9325
Country : US
Telephone Number : 920-855-2823
Fax Number : 920-855-6343
Provider Business Practice Location Address
First Line : 340 N GREEN BAY AVE
Second Line : SUITE 1
City : GILLETT
State : WI
Zip : 54124-9325
Country : US
Telephone Number : 920-855-2823
Fax Number : 920-855-6343
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2005
Last Update Date : 03/18/2013

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Directions to “ MICHELE ANN LADURON APNP” Practice Location

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