Individual
LAURA ERBENTRAUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3410 18TH ST, KENOSHA, WI 53144-1402
(262) 671-1759
(262) 347-3603
Mailing address
3410 18TH ST, KENOSHA, WI 53144-1402
(262) 671-1759
(262) 347-3603
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
WI-560790
WI
Other
Enumeration date
02/06/2015
Last updated
02/06/2015
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