Provider Demographics
NPI:1043239262
Name:LAUS, MARY K (CPNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:K
Last Name:LAUS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:KAREN
Other - Last Name:GOSZKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-2420
Mailing Address - Fax:414-266-6837
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-2420
Practice Address - Fax:414-266-6837
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132876363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1043239262Medicaid
WI736012061Medicare PIN
WI1043239262Medicaid