Individual
LAURA MCKINNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1505 WISCONSIN AVE STE 150, GRAFTON, WI 53024-2075
(262) 421-8961
Mailing address
1505 WISCONSIN AVE STE 150, GRAFTON, WI 53024-2075
(262) 421-8961
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3279-33
WI
364SE0003X
Emergency Clinical Nurse Specialist
3279-033
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
360599200
—
WI
01
—
N/A
N/A
WI
Enumeration date
01/15/2008
Last updated
05/10/2023
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