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NPI Code Detail

MEDICARE: LAURA MARIE TIDWELL APNP

MEDICARE: LAURA MARIE TIDWELL 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
1163W00000XRegistered Nurse141543-30WI
2363LF0000XFamily Nurse Practitioner5705-33WI

General Provider Information

NPI Number : 1669757258
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA MARIE TIDWELL APNP
Provider Business Mailing Address
First Line : 342 N WATER ST STE 600
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-5715
Country : US
Telephone Number : 651-342-1039
Fax Number : 651-342-1428
Provider Business Practice Location Address
First Line : 342 N WATER ST STE 600
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-5715
Country : US
Telephone Number : 651-342-1039
Fax Number : 651-342-1428
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2011
Last Update Date : 05/01/2025

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Directions to “ LAURA MARIE TIDWELL APNP” Practice Location

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