Individual
TIMOTHY S LAUTENSLAGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APNP
Contact information
Practice address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-5753
(920) 433-6000
(920) 430-4719
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
12136-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12136-33
WISCONSIN PROFESSIONAL LICENSE
WI
01
—
F06220495
AMERICAN ACADEMY OF NURSE PRACTITIONER
—
Enumeration date
05/06/2022
Last updated
08/29/2022
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