Doctor Name: | LAURIE S WEGNER-BURNS |
NPI Number: | 1083960835 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | R 149294 7 |
Business Practice Address: | 1020 Marquette Dr Kewaunee, WI - 542161782 |
Business Phone Number: | 9204964700 |
Business Fax Number: | |
Mailing Address: | Po Box 19070, GREEN BAY |
State: | WI |
Postal Code: | 543079070 |
Phone Number: | 9204964700 |
Fax Number: | |
NPI Enumeration Date: | 07/31/2012 |
NPI Last Update Date: | 11/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R 149294 7 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |