Provider Demographics
NPI:1063878643
Name:PIERRE, LAURA M (CPNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:PIERRE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 E EVERGREEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913
Mailing Address - Country:US
Mailing Address - Phone:920-969-5353
Mailing Address - Fax:414-337-7201
Practice Address - Street 1:2575 E EVERGREEN DRIVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8904
Practice Address - Country:US
Practice Address - Phone:920-969-5353
Practice Address - Fax:414-337-7201
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6724-33363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1063878643Medicaid