Provider Demographics
NPI:1912986209
Name:HUEBEL, LAURA A (PA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:HUEBEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W5843 GEHLER RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-9662
Mailing Address - Country:US
Mailing Address - Phone:414-759-4119
Mailing Address - Fax:
Practice Address - Street 1:W5843 GEHLER RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-9662
Practice Address - Country:US
Practice Address - Phone:414-759-4119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1290-23363AM0700X
WI1290363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41982900Medicaid
WIP69476Medicare UPIN
WI41982900Medicaid