Individual
MS. LAURIE ANN MEDIATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.N.
Contact information
Practice address
1019 N CHURCH ST, APT. 102, ELKHORN, WI 53121-1185
(262) 215-6947
Mailing address
1019 N CHURCH ST, APT. 102, ELKHORN, WI 53121-1185
(262) 215-6947
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
312419-031
WI
Other
Enumeration date
09/29/2010
Last updated
09/29/2010
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