Individual
LAI THAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11051 N SHERMAN RD, EDGERTON, WI 53534-9002
(608) 884-3354
(608) 884-5024
Mailing address
11051 N SHERMAN RD, EDGERTON, WI 53534-9002
(608) 884-3354
(608) 884-5024
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
11615
MN
363A00000X
Physician Assistant
Primary
1923-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922059120
—
WI
Enumeration date
05/12/2006
Last updated
06/28/2021
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