Individual
LAURA K VANDERLEI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10005
MN
363AM0700X
Medical Physician Assistant
Primary
2881
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
216911800
—
MN
Enumeration date
01/23/2006
Last updated
05/19/2015
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