Individual
AMY L LAUERSDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
N9163 SKI SLIDE RD, IXONIA, WI 53036-9767
(920) 253-9907
Mailing address
N9163 SKI SLIDE RD, IXONIA, WI 53036-9767
(920) 253-9907
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
308466-031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35032500
—
WI
Enumeration date
06/10/2008
Last updated
06/10/2008
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