Individual
NICHOLAS LARUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8701 W WATERTOWN PLANK RD, MILWAUKEE, WI 53226-3548
(414) 955-8296
Mailing address
4520 N WILSON DR APT 3, SHOREWOOD, WI 53211-1343
(608) 397-0258
Taxonomy
Speciality
Code
Description
License number
State
242T00000X
Perfusionist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6452628968
—
WI
Enumeration date
02/26/2018
Last updated
02/26/2018
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