Provider Demographics
NPI:1164293262
Name:LEDERHAUS, LEXI (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:LEXI
Middle Name:
Last Name:LEDERHAUS
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2992 AUTUMN LN
Mailing Address - Street 2:
Mailing Address - City:EAST TROY
Mailing Address - State:WI
Mailing Address - Zip Code:53120-2572
Mailing Address - Country:US
Mailing Address - Phone:608-604-5470
Mailing Address - Fax:
Practice Address - Street 1:2408 4 MILE RD
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:WI
Practice Address - Zip Code:53402-2091
Practice Address - Country:US
Practice Address - Phone:262-687-5995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14891-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily