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NPI Code Detail

MEDICARE: MS. RUTH ANN NELSON-LAU FNP

MEDICARE: MS. RUTH ANN NELSON-LAU FNP
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 Practitioner92551-030WI
2363LF0000XFamily Nurse Practitioner154WI

General Provider Information

NPI Number : 1598885709
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RUTH ANN NELSON-LAU FNP
Provider Business Mailing Address
First Line : 40 S MAIN ST STE 1300
Second Line :
City : MEMPHIS
State : TN
Zip : 38103-5513
Country : US
Telephone Number : 866-949-0108
Fax Number : 715-539-5150
Provider Business Practice Location Address
First Line : 4321 W. COLLEGE AVE. STE 200
Second Line :
City : APPLETON
State : WI
Zip : 54914-3968
Country : US
Telephone Number : 715-921-9568
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2007
Last Update Date : 04/21/2022

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