Individual
LAURA K KOLLATZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
13250 WASHINGTON AVE, MOUNT PLEASANT, WI 53177-1516
(262) 799-8700
Mailing address
PO BOX 730544, CHICAGO, IL 60673-0001
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
12308
WI
363LA2200X
Adult Health Nurse Practitioner
12308-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100258418
—
WI
Enumeration date
08/02/2023
Last updated
01/25/2024
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